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Pre-traumatic conditions can influence cortisol levels before and after a brain injury

Journal article
Authors Ann Sörbo
I. Eiving
E. Theodorsson
Bertil Rydenhag
I. H. Jonsdottir
Published in Acta Neurologica Scandinavica
Volume 141
Issue 4
Pages 342-350
ISSN 0001-6314
Publication year 2020
Published at Institute of Neuroscience and Physiology
Pages 342-350
Language en
Keywords hair cortisol, pretraumatic conditions, severe brain injury, stress, subarachnoid hemorrhage, acute-phase, adrenal insufficiency, hair, predictors, activation, guidelines, management, sedation, stress, Neurosciences & Neurology
Subject categories Endocrinology and Diabetes, Neurology


Objective Satisfactory anabolic reactions, including the activation of the hypothalamic-pituitary-adrenal (HPA) axis, are essential following severe traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (SAH). Many factors may influence this activation. This study aimed to investigate whether individuals who reported chronic diseases, psychosocial afflictions, or stressful events before a severe brain injury display a different pattern regarding cortisol levels retrospectively and up to three months compared with those who did not report stressful experiences. Materials and Methods Fifty-five patients aged 16-68 years who were admitted to the neurointensive care unit (NICU) were included. Hair cortisol measurements offer a unique opportunity to monitor cortisol levels retrospectively and after the trauma. Hair strands were collected as soon as possible after admission to the NICU and every month until three months after the injury/insult. The participants/relatives were asked about stressful events, psychosocial afflictions and recent and chronic diseases. Results The group who reported chronic diseases and/or stressful events before the brain injury had more than twice as high median hair cortisol levels before the brain injury compared with those who did not report stress, but the difference was not statistically significant (P = .12). Those who reported stress before the brain injury had statistically significantly lower hair cortisol values after the brain injury and they remained until three months after the injury. Conclusions Stressful events and/or chronic disease before brain injury might affect mobilization of adequate stress reactions following the trauma. However, the large variability in cortisol levels in these patients does not allow firm conclusions and more studies are needed.

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