A CASE OF ORTHOSTATIC HYPOTENSION AND RECENT ADVANCES


Daniela Jezova, M.D., Slovak Academy of Sciences, Bratislava, Slovakia

In comparison to coronary heart disease, the pathogenic mechanisms in stroke are very heterogeneous and reliable biomarkers to predict stroke severity and outcome are not available yet. The activation of neuroendocrine functions, particularly those involved in the stress response, represent important aspects of stroke pathophysiology. One of the first responses to cerebral ischemia is the activation of the hypothalamic-pituitary-adrenocortical axis. Increased concentrations of plasma cortisol after stroke were associated with high mortality and poor functional outcome. Moreover, elevated concentrations of circulating aldosterone and mineralocorticoid receptor activation contribute to the development of cerebrovascular pathology and to the incidence and outcome of stroke. Recently, a predictive value of copeptin, a peptide derived from the same precursor as cardiovascular hormone vasopressin, has been demonstrated. The present study was undertaken to determine the value of a battery of neuroendocrine factors with respect to predicting functional outcome of acute stroke within 7 days and 3 months. The sample consisted of 101 patients (46 men, 55 women). The results confirmed the prognostic value of plasma copeptin, in particular the correlation of copeptin concentrations measured on the first day of acute stroke with the clinical state defined by the National Institute of Health Stroke Scale (NIHSS) on day 7. High concentrations of plasma cortisol on day 1 predicted more severe clinical state not only on day 7 but also on day 90. Interestingly, a rapid decrease in cortisol levels during the acute phase of stroke was associated with more detrimental functional outcome (modified Rankin scale). Moreover, poor functional outcome evaluated on day 90 was associated with a pronounced rise of aldosterone concentrations within the first week following stroke. Evaluation of a battery of neuroendocrine factors rather than only one potential biomarker may be a useful approach in stroke outcome prediction. Supported by APVV-0028-10.