Endocrinopathy of critical conditions in hemorrhagic stroke, which required the use of moderate therapeutic hypothermia

Hemorrhagic stroke is a severe and disabling disease. The use of therapeutic hypothermia 35 °С reduced perifocal edema and intracranial pressure.

The aim of the research. Timely detection and adequate correction of endocrinopathy of critical conditions of patients in the acute period of hemorrhagic stroke against the background of moderate therapeutic hypothermia with a target temperature regime of 35 °C.

Materials and methods. Clinical observation of a 57-year-old patient with a diagnosis of "Hemorrhagic stroke with extravasation in the brain stem, volume 7 cm3"

Results. In the phase of maintaining therapeutic hypothermia, a decrease in the level of cortisol and adrenocorticotropic hormone was observed, and in the warming phase, an increase in these indicators was noted. The development of adrenal dysfunction caused by a critical condition and the addition of hydrocortisone to therapy was considered based on the need for vasopressors. The level of thyrotropin (TSH) in the phase of maintaining hypothermia decreased, while in the last day of observation, TSH increased to the middle of the reference values. The level of free triiodothyronine in the maintenance phase decreased below normal, and in the last days increased to reference values. Thyroid dysfunction caused by a critical condition was considered with a decrease in the level of TSH and free triiodothyronine in blood plasma against the background of therapeutic moderate hypothermia, the development of intestinal dysfunction and sinus bradycardia. With this clinical and laboratory picture, levothyroxine sodium was added to therapy.

Conclusion. Against the background of the introduction of hydrocortisone at an initial dose of 300 mg, the addition of norepinephrine was discontinued on the fourth day, after which the dose of hydrocortisone was reduced to complete withdrawal. When levothyroxine sodium was added to therapy 300 mcg / day, intestinal dysfunction was resolved, normosystole was achieved. The patient's quality of life on the Glasgow outcome scale was 5 points.

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