Zaporožskij Medicinskij Žurnal (Jun 2018)
Diagnostic and prognostic value of pituitary-adrenal system hormones in cerebrospinal fluid of patients with acute neuroinfection
Abstract
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).
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