Cortisol axis abnormalities early after stroke - relationships to cytokines and leptin

Objective. To assess the relationships between circulating levels of proinf lammatory cytokines and adrenocortical hormones and leptin early after stro ke. Design. Blood samples were collected four times daily the first two days af ter stroke, twice daily the next 4 days and four times at day 7. Cognitive function and functional outcome was measured at admittance and at day 7. Setting. Consecutive inclusion of patients admitted to the stroke unit at U mea University Hospital. Subjects. Eight men and 4 women with acute stroke and 10 healthy volunteers . Main outcome measures. Levels and diurnal variations of plasma proinflammat ory cytokines interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-al pha), serum adrenocortical hormones (cortisol and DHEA) and leptin, and MMS E, SSS, and ADL scores. Results. A significant correlation was present between IL-6 and cortisol le vels the first two days after stroke (P < 0.05). In patients with a disturb ed diurnal rhythm of cortisol, cortisol and leptin levels were increased (6 8% and 81% increase, respectively), whilst DHEA levels were unaltered. Half of the patients displayed an abnormal diurnal rhythmicity of leptin at the end of the week. Median TNF-alpha levels for the first two days after stro ke also correlated to median leptin levels at the end of the week (P < 0.05 ). Median IL-6 levels correlated to severity of paresis on days 1 and 7 and to MMSE scores on day 7 (P < 0.05). Conclusions. Neuroendocrine disturbances are common and often profound earl y after stroke. Cytokines seem to be important modulators of these disturba nces, including diurnal rhythmicity of cortisol and leptin.