Some Aspects of Pituitary-Adrenal and Autonomic Nervous Systems Functioning in Patients with Chronic Consciousness Disorders

Patients with chronic disorders of consciousness (CDoC) have various variants of the pathological organization of functions including sympathetic hyperactivity and hormonal changes.

The objective: to determine the severity of paroxysmal sympathetic hyperactivity (PSH), the function of the pituitary-adrenal system in patients with CDoC.

Subjects and Methods. 54 patients with CDoC were enrolled in the study. Patients were randomized in the groups depending on assessment on the Coma Recovery Scale-Revised scale and CRS-R index calculation. PSH severity was assessed 7 times a day for two days. During the first week from the moment of admission, blood sampling was performed 7 times a day to study the levels of ACTH and cortisol.

Results. PSH syndrome was detected in all groups, there were no significant dependencies of its severity on the time of day. There were no significant differences in the levels of ACTH and cortisol during the day.

Conclusions: PSH syndrome is observed in most patients with CDoC. In patients with CDoC, the daily rhythm of ACTH and cortisol secretion are disrupted.

1. Grechko A.V., Kiryachkov Yu.Yu., Petrova M.V. Modern aspects of the relationship between the functional state of the autonomic nervous system and clinical and laboratory indices of the body’s homeostasis in brain injuries. Vestnik Intensivnoy Terapii, 2018, no. 2, pp. 79-86. (In Russ.) doi: 10.21320/1818-474X-2018-2-79-86.

2. Kanarskiy M.M., Shtern M.V., Vorobieva I.S. et al. Circadian rhythms and chronic consciousness. Fizicheskaya i Reabilitatsionnaya Meditsina, Meditsinskaya Reabilitatsiya, 2021, vol. 3, no. 4, pp. 340-347. (In Russ.) doi: doi.org/10.36425/rehab63225.

3. Kondratyeva E.A., Dryagina N.V., Aybazova M.I. et al. Prognosis of prolonged disorders of consciousness outcome based on the determination of certain hormones and natriuretic peptide. Messenger of Anesthesiology and Resuscitation, 2019, vol. 16, no. 6, pp. 16-22. (In Russ.) doi: 10.21292/2078-5658-2019-16-6-16-22.

4. Piradov M.A., Suponeva N.A., Voznyuk I.A. et al. Chronic disorders of consciousness: terminology and diagnostic criteria. The results of the first meeting of the Russian Working Group for Chronic Disorders of Consciousness. Аnnaly Klinicheskoy i Eksperimentalnoy Nevrologii, 2020, vol. 14, no. 1, pp. 5-16. (In Russ.) doi: 10.25692/ACEN.2020.1.1.

5. Tsentsiper L.M. Gormonalnye narusheniya u bolnykh v vegetativnom sostoyanii. V kn. Vegetativnoye sostoyaniye. Etiologiya, patogenez, diagnostika. [Hormonal disorders in patients in a vegetative state. In: The vegetative state. Etiology, pathogenesis, and diagnosis]. E.A. Kondratyeva, I.V. Yakovenko, eds., SPb FGBU RNKHI Im. Prof. A. L. Polenova Publ., 2014, Ch. 10, pp. 217-227, ISBN 978-5-225-10023-0.

6. Tsentsiper L.M., Shevelev O.A., Polushin Yu.S. et al. Syndrome of paroxysmal sympathetic hyperactivity: pathophysiology, diagnosis and treatment. Rossiysky Neurokhirurgicheskiy Journal Im. Prof. A.L. Polenova, 2020, vol. XII, no. 4, pp. 59-64. (In Russ.)

7. Baguley I.J., Perkes I.E., Fernandez-Ortega J.F. et al. Paroxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature, and diagnostic criteria. J. Neurotrauma, 2014, no. 31, pp. 1515-1520. doi: 10.1089/neu.2013.3301.

8. Charmandari E., Tsigos C., Chrousos G. Endocrinology of the stress response. Ann. Rev. Physiol., 2005, no. 67, pp. 259-284.

9. Chrousos G.P., Gold P.W. The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA, 1992, vol. 267, no. 9, pp. 1244-1252.

10. Cruse D., Thibaut A., Demertzi A. et al. Actigraphy assessments of circadian sleep-wake cycles in the Vegetative and Minimally Conscious States. BMC Med., 2013, vol. 24, pp. 11-18. doi: 10.1186/1741-7015-11-185.

11. Hellman L., Nakada F., Curti J. et al. Cortisol is secreted episodically by normal man. J. Clin. Endocrinol. Metab., 1970, vol. 30, no. 4, pp. 411-422.

12. Jitka A., Filippini M.M., Bonin E. et al. Diagnostic accuracy of the CRS-R index in patients with disorders of consciousness. Brain Injury, vol. 33, no. 11, pp. pp. 1409-1412. doi: 10.1080/02699052.2019.1644376.

13. Kotchoubey B., Vogel D., Lang S. et al. What kind of consciousness is minimal? Brain Injury, 2014, vol. 28, no. 9, pp. 1156-1163. doi: 10.3109/02699052.2014.920523.

14. Kovács K.J. CRH: the link between hormonal-, metabolic- and behavioral responses to stress. J. Chem. Neuroanat., 2013, no. 5 (4), pp. 25-33. doi: 10.1016/j.jchemneu.2013.05.003.

15. Levy E.R., McVeigh U., Ramsay A.M. Paroxysmal sympathetic hyperactivity (sympathetic storm) in a patient with permanent vegetative state. J. Palliat. Med., 2011, vol. 14, no. 12, pp. 1355-1357. doi: 10.1089/jpm.2010.0444.

16. Lucca L.F., Pignolo L., Leto E. et al. Paroxysmal Sympathetic hyperactivity rate in vegetative or minimally conscious state after acquired brain injury evaluated by paroxysmal sympathetic hyperactivity assessment measure. J. Neurotrauma, 2019, vol. 36, no. 16, pp. 2430-2434. doi: 10.1089/neu.2018.5963.

17. Meyfroidt G., Baguley I.J., Menon D.K. Paroxysmal sympathetic hyperactivity: the storm after acute brain injur. Lancet Neurol., 2017, no. 16, pp. 721-729. doi: 10.1016/S1474-4422(17)30259-4.

18. Partch C.L., Green C.B., Takahashi J.S. Molecular architecture of the mammalian circadian clock. Trends Cell Biol., 2014, vol. 24, no. 2, pp. 90-99. doi: 10.1016/j.tcb.2013.07.002.

19. Pignolo L., Rogano S., Quintieri M. et al. Decreasing incidence of paroxysmal sympathetic hyperactivity syndrome in the vegetative state. J. Rehabil. Med., 2012, vol. 44, no. 6, pp. 502-504. doi: 10.2340/16501977-0981.

20. Van den Berghe G. Neuroendocrine pathobiology of chronic critical illness. Crit Care Clin., 2002, no. 18, pp. 509-528. doi: 10.1016/s0749-0704(02)00007-6.

21. Van den Berghe G., de Zegher F, Bouillon R. Clinical review 95: acute and prolonged critical illness as different neuroendocrine paradigms. J. Clin. Endocrinol. Metab., 1998, vol. 83, no. 6, pp. 1827-1834 doi: 10.1210/jcem.83.6.4763.

22. Vogel H.P., Kroll M., Fritschka E. et al. Twenty-four-hour profiles of growth hormone, prolactin and cortisol in the chronic vegetative state. Clin. Endocrinol. (Oxf), 1990, vol. 33, no. 5, pp. 631-643. doi: 10.1111/j.1365-2265.1990.tb03902.x.

23. Wiencek C., Winkelman Ch. Chronic critical illness prevalence, profile, and pathophysiology. AACN Advanced Crit. Care, 2010, vol. 21, no. 1, pp. 44-61. doi: 10.1097/NCI.0b013e3181c6a162.