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Cited by 60Traumatic Brain Injury and Neurovascular DisturbancesTraumatic Brain Injury ResearchAdrenal Hormones and Disorders

The DOI matches its Crossref record; 36 of the 36 references it cites were found in a registry or an index.

The Adrenocortical Response to Brain Injury: Correlation with the Severity of Neurologic Dysfunction, Effects of Intoxication, and Patient Outcome

Woolf, P. D., Cox, C., Kelly, M., Nichols, D., McDonald, J. V., Hamill, R. W.·1990·Alcoholism Clinical and Experimental Research
DOI 10.1111/j.1530-0277.1990.tb01838.x
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Abstract

To test the hypothesis that cortisol levels reflect the extent of neurologic dysfunction and predict patient outcome, neurologic function and cortisol levels were determined in 120 traumatically brain injured patients who never received glucocorticoid treatment. Their mean age was 29 years and 78% were men. The impact of intoxication was examined in 59 patients who had ethanol levels measured. Ethanol was detectable in 40 patients and ≥ 100 mg/dl in 31. There were significant correlations between the extent of neurologic dysfunction, determined by the Glasgow Coma Score and plasma cortisol concentrations 1 and 4 days postaccident. Cortisol levels were universally elevated on admission and approached normal 7 days later. Multiple linear regression analysis revealed significant effects of circulating ethanol levels on the association between cortisol concentrations and progressively worsening neurologic function, i.e., ethanol reduced the magnitude of the cortisol elevations in a dose dependent manner, abolishing this relationship at levels above 100 mg/dl. Analysis of the relationships between circulating cortisol levels and patient outcome provided a second method for ascertaining the association between injury severity and the magnitude of adrenocortical activation. Admission and day 1 cortisol concentrations were 25 to 40% lower in patients having good recoveries or moderate disabilities than those who remained severely disabled, persistently vegetative or died; serum cortisol values of < 20 μg/dl one day after the accident were more likely to be associated with a good outcome than a poor one (55 vs. 25%, p < 0.001). The worsening prognosis of patients having higher cortisol values is further reflected in the duration of acute hospitalization of these individuals. Thus, in an acute brain injury paradigm there is an excellent time dependent relationship between the severity of illness and the degree of activation of the adrenal cortex. This is reflected in the significant relationship between circulating cortisol levels and the magnitude of neurologic dysfunction and between cortisol concentrations and patient outcome. Ethanol, a frequent compounding factor in head injury, however, moderates the initial adrenocortical response through mechanisms that await clarification.

Overview

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Crossref · 10.1111/j.1530-0277.1990.tb01838.x

Cites

36 of 36 references verified0 citation errors · 0 not checkable

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  • In individuals with preserved hypothalamic-pituitary-adrenal function, early cortisol concentrations generally reflect the degree of physiological stress, with higher levels in more severe injuries.

    “In individuals with preserved hypothalamic–pituitary–adrenal function, early cortisol concentrations generally reflect the degree of physiological stress, with higher levels in more severe injuries [50].”

    From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [50]

  • Admission cortisol levels within a few hours of injury in a person with an intact hypothalamic-pituitary axis tend to directly correlate with injury severity scores and neurologic outcomes.

    “Admission cortisol levels within a few hours of injury in a person with an intact hypothalamic-pituitary axis tend to directly correlate with injury severity scores and neurologic outcomes.”

    From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [31]

  • Lower cortisol levels are seen in milder injury and the highest levels in the most severely injured.

    “Lower cortisol levels are seen in milder injury and the highest levels in the most severely injured [30,31].”

    From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [31]

Citations

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Research works printed but not linked: 2

  1. Yates FE, 1974, Endocrinology, 367
  2. Lecavalier L, 1989, Contributions of gluconeogenesis and glycogenolysis during glucose counterregulation in normal man, Am J Physiol, 256, E844

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Metadata

Authors
Woolf, P. D., Cox, C., Kelly, M., Nichols, D., McDonald, J. V., & Hamill, R. W.
Affiliations
University of Rochester Medicine (US)
Corresponding author
Woolf, P. D.
ORCID
Venue
Alcoholism Clinical and Experimental Research
Publisher
Wiley
Published
1990-12
Volume
14
Issue
6
Pages
917-921
ISSN
  • 0145-6008 (ISSN-L)
  • 1530-0277
DOI
10.1111/j.1530-0277.1990.tb01838.x
OpenAlex
W2068526202
Cited by
60
References
36
Citations by year
2025: 2 · 2023: 2 · 2021: 1 · 2019: 2 · 2018: 3 · 2016: 1 · 2015: 2 · 2013: 4 · 2012: 5
FWCI
0.99
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 5610 d)
Locations
  • Alcoholism Clinical and Experimental Research (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01aa007066-04)
  • National Institute on Alcohol Abuse and Alcoholism (AA07066)
Topics
  • Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
  • Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
traumatic brain injury, cortisol, adrenocortical response, neurologic dysfunction, Glasgow Coma Scale, ethanol intoxication, prognosis, patient outcomes, injury severity, vegetative state, length of hospital stay
MeSH terms
Accidents, Traffic, Adrenal Cortex, Alcoholic Intoxication, Arousal, Brain, Brain Injuries, Female, Follow-Up Studies, Humans, Hydrocortisone, Male, Glasgow Coma Scale

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