Increased adrenocortical activity in patients with vasovagal syncope

IF 3.2 4区医学 Q2 NEUROSCIENCES

Autonomic Neuroscience-Basic & Clinical Pub Date : 2024-06-27 DOI:10.1016/j.autneu.2024.103196

Barbora Bačkorová , Zora Lazúrová , Paulina Lewaskiewicz , Peter Mitro , Ivica Lazúrová

{"title":"Increased adrenocortical activity in patients with vasovagal syncope","authors":"Barbora Bačkorová , Zora Lazúrová , Paulina Lewaskiewicz , Peter Mitro , Ivica Lazúrová","doi":"10.1016/j.autneu.2024.103196","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Syncope is a transient loss of consciousness resulting from cerebral hypoperfusion. Vasovagal syncope (VVS) is a form of orthostatic intolerance (OI). Its clinical signs such as dizziness and hypotension may mimic symptoms of adrenal insufficiency. The objective of this study was to evaluate the adrenal gland function in patients with vasovagal syncope after stimulation with synthetic adrenocorticotropic hormone (ACTH).</p></div><div><h3>Design</h3><p>Case-control study on patients with VVS and healthy controls.</p></div><div><h3>Methods</h3><p>The study involved 42 participants, including 27 patients diagnosed with VVS using the head-up tilt test and 15 healthy individuals with no history of syncope or any orthostatic symptoms. Serum cortisol and aldosterone concentrations were measured under basal conditions and at 30 and 60 min after intramuscular ACTH stimulation.</p></div><div><h3>Results</h3><p>Patients with VVS had significantly higher cortisol levels at baseline (441 ± 143 vs. 331 ± 84.7 nmol/L, <em>p</em> = 0.01), at 30 min (802 ± 143 vs. 686 ± 105 nmol/L, p = 0.01) and at 60 min (931 ± 141 nmol/L vs. 793 ± 147 nmol/L, <em>p</em> = 0.001) after ACTH administration (Synacthen 250 μg). Plasma aldosterone increased after ACTH stimulation, but did not show significant differences among groups. Furthermore, there was also no significant correlation between cortisol levels and blood pressure or heart rate.</p></div><div><h3>Conclusion</h3><p>Patients diagnosed with VVS have higher cortisol levels both at baseline and after ACTH stimulation. This finding indicates that individuals with VVS have higher adrenocortical activity potentially as a response to the orthostatic stress induced by syncope, which acts as a stressful stimulus on the autonomic nervous system.</p></div>","PeriodicalId":55410,"journal":{"name":"Autonomic Neuroscience-Basic & Clinical","volume":"254 ","pages":"Article 103196"},"PeriodicalIF":3.2000,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Autonomic Neuroscience-Basic & Clinical","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S156607022400050X","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"NEUROSCIENCES","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

Syncope is a transient loss of consciousness resulting from cerebral hypoperfusion. Vasovagal syncope (VVS) is a form of orthostatic intolerance (OI). Its clinical signs such as dizziness and hypotension may mimic symptoms of adrenal insufficiency. The objective of this study was to evaluate the adrenal gland function in patients with vasovagal syncope after stimulation with synthetic adrenocorticotropic hormone (ACTH).

Design

Case-control study on patients with VVS and healthy controls.

Methods

The study involved 42 participants, including 27 patients diagnosed with VVS using the head-up tilt test and 15 healthy individuals with no history of syncope or any orthostatic symptoms. Serum cortisol and aldosterone concentrations were measured under basal conditions and at 30 and 60 min after intramuscular ACTH stimulation.

Results

Patients with VVS had significantly higher cortisol levels at baseline (441 ± 143 vs. 331 ± 84.7 nmol/L, p = 0.01), at 30 min (802 ± 143 vs. 686 ± 105 nmol/L, p = 0.01) and at 60 min (931 ± 141 nmol/L vs. 793 ± 147 nmol/L, p = 0.001) after ACTH administration (Synacthen 250 μg). Plasma aldosterone increased after ACTH stimulation, but did not show significant differences among groups. Furthermore, there was also no significant correlation between cortisol levels and blood pressure or heart rate.

Conclusion

Patients diagnosed with VVS have higher cortisol levels both at baseline and after ACTH stimulation. This finding indicates that individuals with VVS have higher adrenocortical activity potentially as a response to the orthostatic stress induced by syncope, which acts as a stressful stimulus on the autonomic nervous system.

查看原文本刊更多论文

血管迷走性晕厥患者肾上腺皮质活动增加。

目的：晕厥是由于脑灌注不足导致的短暂意识丧失。血管迷走性晕厥（VVS）是正性静力性不耐受（OI）的一种形式。其临床表现如头晕和低血压可能与肾上腺功能不全的症状相似。本研究旨在评估血管迷走性晕厥患者在接受合成促肾上腺皮质激素（ACTH）刺激后的肾上腺功能：方法：对血管迷走性晕厥患者和健康对照组进行病例对照研究：研究涉及 42 名参与者，包括 27 名通过仰头倾斜试验确诊为 VVS 的患者和 15 名无晕厥史或任何直立性症状的健康人。研究人员在基础状态下以及肌肉注射促肾上腺皮质激素 30 分钟和 60 分钟后测量了血清皮质醇和醛固酮浓度：结果：VVS 患者在注射促肾上腺皮质激素（Synacthen 250 μg）后，皮质醇水平在基线（441 ± 143 vs. 331 ± 84.7 nmol/L，p = 0.01）、30 分钟（802 ± 143 vs. 686 ± 105 nmol/L，p = 0.01）和 60 分钟（931 ± 141 nmol/L vs. 793 ± 147 nmol/L，p = 0.001）均明显升高。血浆醛固酮在促肾上腺皮质激素刺激后升高，但各组间无显著差异。此外，皮质醇水平与血压或心率之间也没有明显的相关性：结论：确诊为 VVS 的患者在基线和促肾上腺皮质激素刺激后的皮质醇水平都较高。这一发现表明，VVS 患者的肾上腺皮质活性较高，这可能是对晕厥引起的直立性应激的一种反应，晕厥对自主神经系统是一种应激性刺激。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Autonomic Neuroscience-Basic & Clinical 医学-神经科学

CiteScore

5.80

自引率

7.40%

发文量

审稿时长

66 days

期刊介绍： This is an international journal with broad coverage of all aspects of the autonomic nervous system in man and animals. The main areas of interest include the innervation of blood vessels and viscera, autonomic ganglia, efferent and afferent autonomic pathways, and autonomic nuclei and pathways in the central nervous system. The Editors will consider papers that deal with any aspect of the autonomic nervous system, including structure, physiology, pharmacology, biochemistry, development, evolution, ageing, behavioural aspects, integrative role and influence on emotional and physical states of the body. Interdisciplinary studies will be encouraged. Studies dealing with human pathology will be also welcome.