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Byline: Ioanna Dimopoulou (1,3), Stylianos Tsagarakis (2), Evangelia Douka (1), Maria Zervou (1), Andreas T. Kouyialis (1), Urania Dafni (1), Nikolaos Thalassinos (2), Charis Roussos (1) Keywords: Head trauma; Stroke; Critical illness; Cortisol; Low-dose corticotropin stimulation test; Outcome prediction Abstract: Objective To investigate adrenal responses to the low-dose corticotropin (ACTH) stimulation test in acute traumatic or non-traumatic brain injury (BI) and to assess its value in predicting outcome. Design Prospective study. Setting Intensive care unit (ICU) in a university hospital. Patients and participants Seventy-five patients with acute BI, with a median age of 45 years were investigated. BI was due to trauma (n=51), ischemic stroke (n=17), subarachnoid hemorrhage (n=4) or intracerebral hemorrhage (n=3). Interventions Blood was taken on day 16 (median) after admission to the ICU to determine baseline cortisol and ACTH. Thereafter, a low-dose stimulation test (LDST) was performed: 1 Aug of tetracosactrin was injected and 30 min later a second blood specimen was obtained to measure stimulated cortisol. Patients having a stimulated cortisol below 500 nmol/l were defined as non-responders to the LDST. Measurements and results Median baseline and stimulated cortisol were 491 nmol/l and 690 nmol/l, respectively. The median increment in cortisol was 154 nmol/l (range 5--579 nmol/l). Mean ACTH was 46+-21 pg/ml. Ten (13%) patients were non-responders to the LDST these had a higher mortality rate compared to patients with adequate cortisol production (70 vs 32%, p=0.034). Logistic regression analysis revealed that APACHE II (p Conclusions Adrenal hypo-responsiveness in the setting of acute traumatic or non-traumatic BI is not an independent outcome predictor in the presence of high APACHE II, low GCS and older age. Author Affiliation: (1) Department of Critical Care Medicine, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10675, Athens, Greece (2) Department of Endocrinology, Diabetes & Metabolism, Evangelismos Hospital , Medical School, National and Kapodistrian University of Athens, 10675, Athens, Greece (3) 2 Pesmazoglou Street, 14 561, Kifissia, Athens, Greece Article History: Registration Date: 25/03/2004 Received Date: 12/07/2003 Accepted Date: 23/03/2004 Online Date: 21/04/2004

Byline: I. V. Ermakova (1) Abstract: The glucocorticoid function of adrenals was studied in 23 first-year schoolboys that were subdivided into health groups I and II. The character and time organization of the infradian dynamics of the cortisol were studied during the period of acute adaptation to the beginning of schooling and throughout the school year. The schoolboys of health group II were different from those of group I by both the higher level of the week mesor and its dynamics during the entire school year. By the end of the first half of the year, the structure of cortisol infradian rhythms was changed in the first-year schoolboys of group II: the slow rhythms of cortisol secretion with the period of five to seven days became predominant, and the fact that the absolute values of their amplitudes were significantly increased suggested a tension in the functions of the adrenal cortex. Author Affiliation: (1) Institute of Developmental Physiology, Russian Academy of Education, Moscow, Russia Article History: Registration Date: 12/10/2004

Abstract: Utilization of the daily rhythm of ACTH secretion was assessed as a measure of the adequacy of replacement therapy in primary chronic adrenal failure (PCAF Addison's disease) with glucocorticoids (GC) by assaying plasma ACTH by radioimmunoassay every 4 h for one day in three groups of patients. Patients of group 1 had PCAF (n = 14) and received replacement therapy consisting of prednisolone (5 mg at 09:00 and 2.5 mg at 14:00) and group 2 patients received dexamethasone (0.5 mg at 23:00) in combination with prednisolone (2.5 mg at 14:00). All patients with PCAF also received 0.005--0.01 mg/day of 9[alpha]-fluorocortisol. The control group consisted of 14 healthy volunteers. Both types of replacement therapy resulted in high levels of variability in ACTH levels as compared with that in normal subjects. The areas under the curve (AUC) of the ACTH concentration over one day were not significantly different between groups 1 and 2 or between group 2 and controls. The AUC of ACTH in group 1 was significantly larger than that in controls. The mean ACTH concentration in group 1 at 07:00 and 11:00 was significantly greater than those in the other two groups. The daily rhythm of ACTH was generally closer to normal in patients given dexamethasone. Since our own clinical experience shows that at least two thirds of patients are initially given dexamethasone and that this had to be withdrawn because of the development of overdosage syndrome (weight gain, increased appetite, insomnia), it appears that there is a lack of concordance between the clinical data and the daily rhythm of ACTH secretion. When assessing the adequacy of replacement therapy in PCAF, it is important to note that the appearance of a normal rhythm of ACTH secretion over one day does not exclude the possibility of GC overdosage, with the effect that interpretation of the results of this type of measurement must take the clinical picture into account. Article History: Registration Date: 08/10/2004

Byline: F. G. Sitdikov (1), M. V. Shaikhelislamova (1), I. R. Valeev (1), L. Yu. Kuz'mina (1) Author Affiliation: (1) Kazan State Pedagogical University, Kazan, Tatarstan, 420021, Russia Article History: Registration Date: 06/10/2004