Diagnostic and prognostic value of pituitary-adrenal system hormones in cerebrospinal fluid of patients with acute neuroinfection
DOI:
https://doi.org/10.14739/2310-1210.2018.3.130521Keywords:
meningitis, ACTH, hydrocortisone, aldosterone, cerebrospinal fluid, diagnosisAbstract
The purpose of the work. To determine the diagnostic and predictive significance of the pituitary-adrenal system hormones levels in the cerebrospinal fluid of patients with acute neuroinfections due to different etiology.
Materials and methods. A complete physical examination of 164 patients with acute neuroinfection who were treated in the Kharkiv Regional Clinical Infectious Diseases Hospital (Kharkiv, Ukraine) was performed. In addition to the clinical course of disease analysis, we examined the CSF of patients for ACTH, aldosterone and cortisol levels determination on admission and on the 10–12th day of treatment.
Results. The data demonstrate an increase in the levels of ACTH, aldosterone and cortisol depending on the severity of patient's condition and the disease etiology. In patients with severe neuroinfection on the 1 day of treatment all hormones levels were significantly higher by contrast to patients with moderate severity both in viral and bacterial neuroinfections (P < 0.001). We have found a strong inverse correlation between the aldosterone level and the degree of consciousness disturbance on the Glasgow scale (r = -0.71). At the 10–12th day of treatment levels of hormones decreased in patients of all groups (P < 0.05). However, cortisol levels remained high in patients with severe course of disease (P < 0.001) in comparison with moderate degree of severity, aldosterone levels were significantly higher in patients with bacterial meningitis than in viral etiological process (P < 0.05). It is notable that ACTH levels were significantly higher in patients with moderate degree of severity on the 10–12th day of bacterial meningitis treatment, while ACTH levels were higher in patients with severe course of viral meningitis (P < 0.05).
Conclusions. The level of pituitary-adrenal hormones in cerebrospinal fluid in patients with acute neuroinfection depends on both the severity and the etiology of the disease. The highest levels of ACTH, aldosterone and cortisol were observed in severe patients on the first day of hospitalization. The cortisol level in the CSF above 115 nmol / l is a prognostic criterion for an unfavourable course of disease. The aldosterone level in the CSF of patients has an inverse correlation with the degree of consciousness disorder according to the Glasgow scale (r = – 0.71), (P < 0.05).
References
Mount, H. R., & Boyle, S. D. (2017) Aseptic and Bacterial Meningitis: Evaluation, Treatment, and Prevention. Am Fam Physician, 96(5), 314–322.
Hladky, S. B., & Barrand, M. A. (2016) Fluid and ion transfer across the blood–brain and blood–cerebrospinal fluid barriers; a comparative account of mechanisms and roles. Fluids and Barriers of the CNS., 13(1), 19. doi: 10.1186/s12987-016-0040-3.
Saunders, N. R., Dziegielewska, K. M., Møllgård, K., & Habgood, M. D. (2015) Markers for blood–brain barrier integrity: how appropriate is Evans blue in the twenty–first century and what are the alternatives? Frontiers in Neuroscience, Frontiers in Neuroscience. doi:10.3389/fnins.2015.00385.
Russell, G. M., Kalafatakis, K., & Lightman, S. L. (2015) The importance of biological oscillators for hypothalamic–pituitary–adrenal activity and tissue glucocorticoid response: coordinating stress and neurobehavioural adaptation. J Neuroendocrinol. 27(6), 378–88. doi: 10.1111/jne.12247.
Spiga, F., Walker, J. J., Gupta, R., Terry, J. R., & Lightman, S. L. (2015) 60 years of neuroendocrinology. Glucocorticoid dynamics: insights from mathematical, experimental and clinical studies. J Endocrinol, 226(2), T55–66. doi: 10.1530/JOE–15–0132.
Resch, J. M., Fenselau, H., Madara, J. C., Wu, C., Campbell, J. N., Lyubetskaya, A. et al. (2017) Aldosterone–Sensing Neurons in the NTS Exhibit State–Dependent Pacemaker Activity and Drive Sodium Appetite via Synergy with Angiotensin II Signaling. Neuron, 96(1), 190–206.e7. doi: 10.1016/j.neuron.2017.09.014.
Hall, J. E., do Carmo, J. M., da Silva, A. A., Wang, Z., & Hall, M. E. (2015) Obesity–induced hypertension: interaction of neurohumoral and renal mechanisms. Circulation research., 116(6), 991–1006. doi: 10.1161/CIRCRESAHA.116.305697.
Gomez–Sanchez, E. P., Gomez–Sanchez, C. M., Plonczynski, M., & Gomez–Sanchez, C. E. (2010) Aldosterone synthesis in the brain contributes to Dahl salt–sensitive rat hypertension. Experimental physiology, 95(1), 120–130. doi:10.1113/expphysiol.2009.048900.
Adrogué, H. J., & Madias, N. E. (2017) Sodium and potassium in the pathogenesis of hypertension: focus on the brain. Curr Opin Nephrol Hypertens, 26(2), 106–113. doi: 10.1097/MNH.0000000000000301.
Mook-Kanamori, B. B., Geldhoff, M., van der Poll, T., & van de Beek, D. (2011) Pathogenesis and Pathophysiology of Pneumococcal Meningitis. Clinical Microbiology Reviews, 24(3), 557–591. doi: 10.1128/CMR.00008–11.
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)