Endocrine Abstracts

Introduction: Acute ischaemic stroke is a stressful condition in which there is marked increase in the production of cortisol. In the past adrenal insufficiency in critically ill patients had been shown to be associated with significant morbidity and mortality. To date there is no study performed to determine its prevalence among patients with acute ischaemic stroke.

Objectives: The aim of this study is to determine the prevalence of relative adrenal insufficiency in acute ischaemic stroke by utilizing the low dose (LD) and standard dose (SD) synacthen tests and to correlate it with inpatient hospital morbidity and mortality.

Method: Fifty-eight patients who fulfilled the diagnosis of acute ischaemic stroke within 72 h onset of a stroke were subjected to LD (1 μg) synacthen test (LDST) and 2 h later SD (250 μg) synacthen test (SDST).

Result: Based on an increment of <250 nmol/l after LDST, 38 (65.5%) patients had relative adrenal insufficiency, however using similar criteria with the SDST, only 18 (31.0%) patients had relative adrenal insufficiency. Three patients died during the study period and they had a tendency to have high baseline cortisol levels. Interestingly the non-survivors failed to mount any significant cortisol responses to both LDST and SDST. All of the non-survivors had a significant higher FBS (P=0.006) and poorly controlled diabetes mellitus. The diagnosis of relative adrenal insufficiency in general was not associated with any other significant clinical outcomes.

Conclusion: This is the first study demonstrating the prevalence of relative adrenal insufficiency amongst acute ischaemic stroke patients Utilizing the LDST, relative adrenal insufficiency was found in 65.5% of patients admitted with acute ischaemic stroke in which more sensitive compared to SDST. Mortality in our cohort of stroke patients was associated with failure to mount a cortisol response to both LDST and SDST.

Keywords:: ischaemic stroke, synacthen test, low dose synacthen test, standard dose synacthen test, adrenal insufficiency, Scandinavian stroke score