A Study on Correlation between Serum Cortisol and Stroke Severity

INTRODUCTION: A stress response consisting of increased levels of cortisol and catecholamines in the first weeks after acute stroke has been known since the 1950s, and a failure of dexamethasone suppression of cortisol levels indicated a dysregulation of the hypothalamic pituitary adrenal (HPA) system1.The cortisol response has been identified in both cerebral infarction and intracerebralhaemorrhage. High s-cortisol levels have been related to poor outcome. It is, however, not known whether this adrenal glucocorticoid stress response is beneficial or harmful to the damaged brain. The cortisol response is related positively to blood glucose a parameter that increases after severe stroke possibly resulting from the stress response. It has been reported that cortisol correlated positively to white blood cell count, fibrinogen, and other markers of the inflammatory response after stroke as well as IL-6, and it was suggested that cytokines modulate the cortisol response after acute stroke11 by stimulating the HPA axis leading to increased levels of cortisol in the periphery. Some researchers suggested that the association between high stress hormone levels and less favourable outcome could be related to cardiac abnormalities resulting from the increased levels of stress-hormones. In one study, the degree of sympathetic activation was associated with the extent of the damage to the insula, which is assumed to be involved in the regulation of the autonomic nervous system13. Insular damage in experimental stroke has also been shown to result in an increase in the circulating levels of catecholamines suggesting this as a mechanism for the cardiac complications associated with stroke. It has also been observed that the normal circadian rhythm of cortisol is suspended during acute stroke as equal levels of cortisol were found round the clock. Whether the stress response is just an epiphenomenon to stroke severity or independently contributes to prognosis remains uncertain. Furthermore, the stress response has not yet been put in perspective by evaluation in the context of parameters generally assumed to be of importance in acute stroke. AIM OF THE STUDY: 1. The aim of the study was to investigate if a single serum cortisol determination related to stroke severity. 2. If cortisol is related to paraclinical parameters in acute stroke in order to gain knowledge of the relations between cortisol and other paraclinical variables of known relevance to stroke. MATERIALS AND METHODS: The study included 60 patients with acute stroke in the study within 24 h of stroke onset after informed consent. The patients were recruited from medical wards in government general hospital. Of them, 13 patients we excluded as per exclusion criteria. The remaining 47 patients were selected for the study. Exclusion criteria: 1. Pregnancy, 2. Liver disease, 3. Age