HYPERCORTISOLISM AFTER STROKE - PARTLY CYTOKINE-MEDIATED

Increased activity of the hypothalamic-pituitary-adrenal (HPA) axis is common early after stroke. Hypercortisolism is a prominent manifestat ion. Normally the secretion of cortisol is regulated by adrenocorticot rophic hormone (ACTH), but recently an ACTH/cortisol dissociation afte r stroke was reported. Cytokines may influence the HPA axis, and plasm a IL-6 levels are elevated following stroke. We investigated correlati ons between cortisol, ACTH, and cytokines, and between blood pressure and blood hormone levels early after stroke in seven stroke patients. All had neurological symptoms secondary to brain infarctions. Blood sa mples for analysis of cortisol, ACTH, IL-6, TNF alpha, norepinephrine, and epinephrine were collected four times daily, and 24-h blood press ure was measured. Plasma IL-6, but not ACTH, correlated significantly to serum cortisol. Catecholamine levels correlated with cytokine and c ortisol levels. This study suggests that several routes for HPA-axis d ysregulation is present early after stroke. Cytokine release may play an important role in this situation. (C) 1997 Elsevier Science B.V.