ymjЯкутский медицинский журналYakut Medical Journal1813-19052312-1017ЯНЦ КМП10.25789/YMJ.2023.83.30ymj-347Research ArticleСЛУЧАЙ ИЗ ПРАКТИКИCLINICAL CASEНадпочечниковая и тиреоидная дисфункции при нетравматическом субарахноидальном кровоизлиянии, потребовавшем применения терапевтической нормотермии. Клиническое наблюдениеAdrenal and thyroid dysfunction in non-traumatic subarachnoid hemorrhage requiring therapeutic normothermia. Clinical observationhttps://orcid.org/0000-0001-5646-0055АльтшулерН. Э.AltshulerN. E.

АЛЬТШУЛЕР Натаван Эльшад – к.м.н., врач-эндокринолог, врач анестезиолог-реаниматолог, ассистент кафедры

ALTSHULER Natavan Elshad – MD, anesthesiologist and intensive care specialist, endocrinologist, assistant of the Department of Anesthesia and intensive care of Medicobiological University of Innovation and Continuing Education

natavan.altschuler@gmail.comhttps://orcid.org/0000-0001-5011-6288КругляковН. М.KruglyakovN. M.

КРУГЛЯКОВ Николай Михайлович – врач анестезиолог-реаниматолог, зав. отд.

KRUGLYAKOV Nikolay Mihajlovich – anesthesiologist and intensive care specialist, Head of Anesthesia and Intensive Care Service

https://orcid.org/0000-0003-3363-5195БагжановГ. И.BagzhanovG. I.

БАГЖАНОВ Герман Игоревич – врач анестезиолог-реаниматолог, ассистент кафедры

BAGZHANOV German Igorevich – anesthesiologist and intensive care specialist, assistant of the Department of Anesthesia and intensive care of Medico-biological University of Innovation and Continuing Education

https://orcid.org/0000-0003-1945-323XПопугаевК. А.PopugaevK. A.

ПОПУГАЕВ КонстантинАлександрович – д.м.н., проф., зав. кафедрой; зам. директора – руковод. региональн. сосудист. центра НИИ СП им Н.В. Склифосовского ДЗМ

POPUGAEV Konstantin Aleksandrovich – MD, PhD, professor of intensive care, head of the Regional Vascular Center of the N.V. Sklifosovskii Research Institute for Emergency Medicine of Moscow Healthcare Department; head of the Department of Anesthesiology, Resuscitation Intensive Care, A.I. Burnasyan Federal Medical Biophysical Center FMBA

Moscow

https://orcid.org/0000-0003-0096-905XКуцыйМ. Б.KutcyiM. B.

КУЦЫЙ Михаил Борисович – к.м.н., врач анестезиолог-реаниматолог, руковод. Операционного центра

KUTCYI Mikhail Borisovich – MD, anesthesiologist and intensive care specialist, chief of Operation center, European Medical Center

https://orcid.org/0000-0002-6936-6188АникьеваЕ. А.AnikyevaE. A.

АНИКЬЕВА Евгения Анатольевна – врач-кардиолог

ANIKYEVA Evgeniya Anatolevna – cardiologist

https://orcid.org/0000-0003-1837-3588ДокукинА. А.DokukinA. A.

ДОКУКИН Алексей Анатольевич – врач анестезиолог-реаниматолог

DOKUKIN Aleksey Anatolevich – anesthesiologist and intensive care specialist

Медико-биологич. ун-т инноваций и непрерывного образования Гос. научн. центра Российской Федерации – Федеральн. медицин. биофизич. центра им. А.И. БурназянаРоссияA.I. Burnasyan Federal Medical Biophysical Center FMBARussian FederationМедико-биологич. ун-т инноваций и непрерывного образования Гос. научн. центра Российской Федерации – Федеральн. медицин. биофизич. центра им. А.И. БурназянаРоссияA.I. Burnazyan Federal Medical Biophysical Center FMBARussian FederationАО «Европейский медицинский центр»РоссияEuropean Medical CenterRussian Federation20231002202503120123Copyright © Альтшулер Н.Э., Кругляков Н.М., Багжанов Г.И., Попугаев К.А., Куцый М.Б., Аникьева Е.А., Докукин А.А., 20252025Альтшулер Н.Э., Кругляков Н.М., Багжанов Г.И., Попугаев К.А., Куцый М.Б., Аникьева Е.А., Докукин А.А.Altshuler N.E., Kruglyakov N.M., Bagzhanov G.I., Popugaev K.A., Kutcyi M.B., Anikyeva E.A., Dokukin A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://ymj.elpub.ru/jour/article/view/347

Представленное клиническое наблюдение является демонстрацией важности своевременного выявления и адекватной коррекции эндокринопатии критических состояний у пациентов в острейшем периоде субарахноидального кровоизлияния на фоне терапевтической нормотермии с целевым температурным режимом 36 °С.

Subarachnoid hemorrhage (SAH) is a life-threatening variant of hemorrhagic stroke. Therapeutic normothermia to reduce the risk of adverse outcomes. At the same time, the initially existing decompensation of body systems, followed by induced normothermia, gives impetus to the development of a number of pathophysiological processes in the human body.

Objective

Objective. Timely detection and adequate correction of endocrinopathy of critical illness in patients in the most acute period of SAH against the background of therapeutic normothermia with a target temperature regime of 36 °C.

Materials and methods

Materials and methods. A 57-year-old patient with a diagnosis of non-traumatic subarachnoid hemorrhage, saccular aneurysm of the anterior communicating artery and anterior cerebral artery, Hunt Hess III.

Results

Results. The development of critically ill adrenal dysfunction considered based on the need for vasopressors. Thyroid dysfunction caused by a critical illness considered with a decrease in the level of TSH and free T3 in blood plasma against the background of therapeutic normothermia, the development of intestinal dysfunction and sinus bradycardia.

Conclusions

Conclusions. Against the background of the introduction of hydrocortisone at an initial dose of 300 mg, the administration of norepinephrine discontinued on the third day. When levothyroxine sodium 300 mcg/day added to therapy, intestinal dysfunction resolved, normal resting heart rate achieved.

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The authors declare that there are no conflicts of interest present.