Relative adrenal insufficiency amongst hospitalized mild to moderate acute ischemic stroke patients

Acute ischemic stroke is a stressful condition where there is marked increase in the production of cortisol. In the past, adrenal insufficiency in critically ill patients had been shown to be associated with significant morbidity and mortality. To date, there have been no studies performed to determine its prevalence among patients with acute ischemic stroke. The aim of this study was to determine the prevalence of relative adrenal insufficiency in acute ischemic stroke by utilizing low dose (LD) and standard dose (SD) synacthen tests and to correlate it with inpatient hospital morbidity and mortality. Fifty-eight patients who fulfilled the diagnosis of acute ischemic stroke within 72 hours from the onset of a stroke were subjected to LD (1µg) synacthen test (LDST) and two hours later to SD (250 µg) synacthen test (SDST). Based on an increment of less than 250 nmol/L after LDST, 38 (65.5%) patients had relative adrenal insufficiency. However, using similar criteria with the SDST, only 18 (31.0%) patients had relative adrenal insufficiency. Three patients died during the study period and they had a tendency to have high baseline cortisol levels. The diagnosis of relative adrenal insufficiency in general was not associated with any other significant clinical outcomes. This is the first study demonstrating the prevalence of relative adrenal insufficiency amongst acute ischemic stroke patients. Utilizing the LDST, relative adrenal insufficiency was found more sensitive in detecting relative adrenal insufficiency in patients with acute ischemic stroke as compared to SDST.