Adrenal and thyroid dysfunction in non-traumatic subarachnoid hemorrhage requiring therapeutic normothermia. Clinical observation
N. E. Altshuler,
N. M. Kruglyakov,
G. I. Bagzhanov,
K. A. Popugaev,
M. B. Kutcyi,
E. A. Anikyeva,
A. A. Dokukin https://doi.org/10.25789/YMJ.2023.83.30
Abstract
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. 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. 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. 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. 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.
About the Authors
N. E. Altshuler
A.I. Burnasyan Federal Medical Biophysical Center FMBA
Russian Federation
Russian Federation
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
N. M. Kruglyakov
A.I. Burnasyan Federal Medical Biophysical Center FMBA
Russian Federation
Russian Federation
KRUGLYAKOV Nikolay Mihajlovich – anesthesiologist and intensive care specialist, Head of Anesthesia and Intensive Care Service
G. I. Bagzhanov
A.I. Burnazyan Federal Medical Biophysical Center FMBA
Russian Federation
Russian Federation
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
K. A. Popugaev
A.I. Burnasyan Federal Medical Biophysical Center FMBA
Russian Federation
Russian Federation
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
M. B. Kutcyi
European Medical Center
Russian Federation
Russian Federation
KUTCYI Mikhail Borisovich – MD, anesthesiologist and intensive care specialist, chief of Operation center, European Medical Center
E. A. Anikyeva
European Medical Center
Russian Federation
Russian Federation
ANIKYEVA Evgeniya Anatolevna – cardiologist
A. A. Dokukin
European Medical Center
Russian Federation
Russian Federation
DOKUKIN Aleksey Anatolevich – anesthesiologist and intensive care specialist
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Review
For citations:
Altshuler N.E., Kruglyakov N.M., Bagzhanov G.I., Popugaev K.A., Kutcyi M.B., Anikyeva E.A., Dokukin A.A. Adrenal and thyroid dysfunction in non-traumatic subarachnoid hemorrhage requiring therapeutic normothermia. Clinical observation. Yakut Medical Journal. 2023;(3):120-123. https://doi.org/10.25789/YMJ.2023.83.30
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