Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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The Unique Relationship between Neuro-Critical Care and Critical Illness-Related Corticosteroid Insufficiency : Implications for Neurosurgeons in Neuro-Critical Care

  • Yoon Hee Choo (Department of Neurological Surgery and Critical Care Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Moinay Kim (Department of Neurological Surgery and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jae Hyun Kim (Department of Neurological Surgery and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hanwool Jeon (Department of Neurological Surgery and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hee-Won Jung (Department of Neurological Surgery and Critical Care Medicine, Chungnam National University Hospital) ;
  • Eun Jin Ha (Department of Neurological Surgery and Critical Care Medicine, Seoul National University Hospital) ;
  • Jiwoong Oh (Department of Neurological Surgery and Critical Care Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Youngbo Shim (Department of Neurological Surgery and Critical Care Medicine, Kangbuk Samsung Hospital) ;
  • Seung Bin Kim (Department of Neurological Surgery and Critical Care Medicine, Seoul National University Boramae Medical Center) ;
  • Han-Gil Jung (Department of Neurological Surgery and Critical Care Medicine, Seoul National University Bundang Hospital) ;
  • So Hee Park (Department of Neurological Surgery and Critical Care Medicine, Yeungnam University Medical Center) ;
  • Jung Ook Kim (Department of Neurological Surgery and Critical Care Medicine, Gachon University Gil Hospital Regional Trauma Center) ;
  • Junhyung Kim (Department of Neurological Surgery and Critical Care Medicine, Gangnam Severance Hospital) ;
  • Hyeseon Kim (Department of Neurological Surgery and Critical Care Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea) ;
  • Seungjoo Lee (Department of Neurological Surgery and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2023.03.23
  • Accepted : 2022.06.07
  • Published : 2023.11.01
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Abstract

The brain houses vital hormonal regulatory structures such as the hypothalamus and pituitary gland, which may confer unique susceptibilities to critical illness-related corticosteroid insufficiency (CIRCI) in patients with neurological disorders. In addition, the frequent use of steroids for therapeutic purposes in various neurological conditions may lead to the development of steroid insufficiency. This abstract aims to highlight the significance of understanding these relationships in the context of patient care and management for physicians. Neurological disorders may predispose patients to CIRCI due to the role of the brain in hormonal regulation. Early recognition of CIRCI in the context of neurological diseases is essential to ensure prompt and appropriate intervention. Moreover, the frequent use of steroids for treating neurological conditions can contribute to the development of steroid insufficiency, further complicating the clinical picture. Physicians must be aware of these unique interactions and be prepared to evaluate and manage patients with CIRCI and steroid insufficiency in the context of neurological disorders. This includes timely diagnosis, appropriate steroid administration, and careful monitoring for potential adverse effects. A comprehensive understanding of the interplay between neurological disease, CIRCI, and steroid insufficiency is critical for optimizing patient care and outcomes in this complex patient population.

Keywords

Acknowledgement

This research was supported by a grant from the Korean Government Ministr y of Science and ICT (MSIT) (2022R1A2C2011941), and Asan Institute for Life Sciences, Asan Medical Center - 2023IP0040, 2023IP0037, 2023IP0111 (Seoul, Republic of Korea), and Digital Healthcare Research Grant through the Seokchun Caritas Foundation (SCY2107P).

References

  1. Annane D, Pastores SM, Arlt W, Balk RA, Beishuizen A, Briegel J, et al. : Critical illness-related corticosteroid insufficiency (CIRCI): a narrative review from a multispecialty task force of the society of critical care medicine (SCCM) and the european society of intensive care medicine (ESICM). Intensive Care Med 43 : 1781-1792, 2017 https://doi.org/10.1007/s00134-017-4914-x
  2. Annane D, Pastores SM, Rochwerg B, Arlt W, Balk RA, Beishuizen A, et al. : Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (part I): society of critical care medicine (SCCM) and european society of intensive care medicine (ESICM) 2017. Intensive Care Med 43 : 1751-1763, 2017 https://doi.org/10.1007/s00134-017-4919-5
  3. Arlt W, Stewart PM : Adrenal corticosteroid biosynthesis, metabolism, and action. Endocrinol Metab Clin North Am 34 : 293-313, viii, 2005 https://doi.org/10.1016/j.ecl.2005.01.002
  4. Bendel S, Koivisto T, Ruokonen E, Rinne J, Romppanen J, Vauhkonen I, et al. : Pituitary-adrenal function in patients with acute subarachnoid haemorrhage: a prospective cohort study. Crit Care 12 : R126, 2008
  5. Broersen LH, Pereira AM, Jorgensen JO, Dekkers OM : Adrenal insufficiency in corticosteroids use: systematic review and meta-analysis. J Clin Endocrinol Metab 100 : 2171-2180, 2015 https://doi.org/10.1210/jc.2015-1218
  6. Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. : Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery 80 : 6-15, 2017 https://doi.org/10.1227/NEU.0000000000001432
  7. Cohan P, Wang C, McArthur DL, Cook SW, Dusick JR, Armin B, et al. : Acute secondary adrenal insufficiency after traumatic brain injury: a prospective study. Crit Care Med 33 : 2358-2366, 2005 https://doi.org/10.1097/01.CCM.0000181735.51183.A7
  8. Cooper MS, Stewart PM : Corticosteroid insufficiency in acutely ill patients. N Engl J Med 348 : 727-734, 2003 https://doi.org/10.1056/NEJMra020529
  9. Dimopoulou I, Tsagarakis S, Kouyialis AT, Roussou P, Assithianakis G, Christoforaki M, et al. : Hypothalamic-pituitary-adrenal axis dysfunction in critically ill patients with traumatic brain injury: incidence, pathophysiology, and relationship to vasopressor dependence and peripheral interleukin-6 levels. Crit Care Med 32 : 404-408, 2004 https://doi.org/10.1097/01.CCM.0000108885.37811.CA
  10. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. : Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47 : 1181-1247, 2021 https://doi.org/10.1007/s00134-021-06506-y
  11. Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, et al. : 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke 53 : e282-e361, 2022
  12. Joseph RM, Hunter AL, Ray DW, Dixon WG : Systemic glucocorticoid therapy and adrenal insufficiency in adults: a systematic review. Semin Arthritis Rheum 46 : 133-141, 2016 https://doi.org/10.1016/j.semarthrit.2016.03.001
  13. Karamouzis I, Pagano L, Prodam F, Mele C, Zavattaro M, Busti A, et al. : Clinical and diagnostic approach to patients with hypopituitarism due to traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), and ischemic stroke (IS). Endocrine 52 : 441-450, 2016 https://doi.org/10.1007/s12020-015-0796-2
  14. Laugesen K, Broersen LHA, Hansen SB, Dekkers OM, Sorensen HT, Jorgensen JOL : Management of endocrine disease: glucocorticoid-induced adrenal insufficiency: replace while we wait for evidence? Eur J Endocrinol 184 : R111-R122, 2021 https://doi.org/10.1530/EJE-20-1199
  15. Liu D, Ahmet A, Ward L, Krishnamoorthy P, Mandelcorn ED, Leigh R, et al. : A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol 9 : 30, 2013
  16. Marik PE, Pastores SM, Annane D, Meduri GU, Sprung CL, Arlt W, et al. : Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med 36 : 1937-1949, 2008 https://doi.org/10.1097/CCM.0b013e31817603ba
  17. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. : Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 50 : e344-e418, 2019
  18. Powner DJ, Boccalandro C : Adrenal insufficiency following traumatic brain injury in adults. Curr Opin Crit Care 14 : 163-166, 2008 https://doi.org/10.1097/MCC.0b013e3282f57528
  19. Prete A, Bancos I : Glucocorticoid induced adrenal insufficiency. BMJ 374 : n1380, 2021
  20. Schneider HJ, Kreitschmann-Andermahr I, Ghigo E, Stalla GK, Agha A : Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review. JAMA 298 : 1429-1438, 2007 https://doi.org/10.1001/jama.298.12.1429
  21. Tanriverdi F, De Bellis A, Bizzarro A, Sinisi AA, Bellastella G, Pane E, et al. : Antipituitary antibodies after traumatic brain injury: is head trauma-induced pituitary dysfunction associated with autoimmunity? Eur J Endocrinol 159 : 7-13, 2008 https://doi.org/10.1530/EJE-08-0050
  22. Tanriverdi F, De Bellis A, Ulutabanca H, Bizzarro A, Sinisi AA, Bellastella G, et al. : A five year prospective investigation of anterior pituitary function after traumatic brain injury: is hypopituitarism long-term after head trauma associated with autoimmunity? J Neurotrauma 30 : 1426-1433, 2013 https://doi.org/10.1089/neu.2012.2752
  23. Villar J, Ferrando C, Martinez D, Ambros A, Munoz T, Soler JA, et al. : Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med 8 : 267-276, 2020 https://doi.org/10.1016/S2213-2600(19)30417-5
  24. Weant KA, Sasaki-Adams D, Dziedzic K, Ewend M : Acute relative adrenal insufficiency after aneurysmal subarachnoid hemorrhage. Neurosurgery 63 : 645-649; discussion 649-650, 2008 https://doi.org/10.1227/01.NEU.0000325728.50939.15
  25. Wijdicks EF, Findlay JY, Freeman WD, Ayan Sen M : Mayo clinic critical and neurocritical care board review. Oxford : Oxford University Press, 2019