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Insuffisance corticotrope à la phase aiguë des hémorragies sous-arachnoïdiennes non graves: impact sur la survenue de complications et le pronostic fonctionnel à 1 mois 41 pages, 3 figures, 4 tableaux, 30 cm -Thèse de Médecine, Rennes, vol.1, 2018. ,
, Matériels et méthodes: Les HSA non graves (grade WFNS ?3) sur rupture d'anévrysme endocrânien étaient incluses. Les dosages hormonaux réalisés dans les 48 premières heures étaient : cortisolémie plasmatique, ACTH plasmatique et test au Synacthène® (250 microg). L'insuffisance corticotrope était définie par une cortisolémie plasmatique <100 ng/ml et/ou un test au Synacthène® négatif (delta cortisol <90 ng/ml). Les patients étaient suivis sur 30 jours avec recensement des complications : vasospasme, ischémie cérébrale retardée, resaignement, épilepsie, hydrocéphalie et infection. A J30, le Glasgow outcomescale (GOS), le score de Rankin modifié (mRS) et le Short Form-12 (SF-12) étaient calculés. Résultats: 52 patients ont été inclus de juin 2013 à mars 2016. L'incidence de l'insuffisance corticotrope (CIRCI) est de 17.3% à la phase aiguë. Le taux de complications était de 78% dans le groupe CIRCI contre 44% dans le groupe non CIRCI sans corrélation statistique entre l'état de CIRCI et la survenue de complications, excepté en ce qui concerne les infections. L'insuffisance corticotrope n'était pas statistiquement associée à un pronostic fonctionnel plus défavorable à 1 mois. Conclusion : L'insuffisance corticotrope est fréquente à la phase aiguë d'une HSA, Les hémorragies sous arachnoïdiennes (HSA) sont des situations de stress aigu pouvant être aggravées par des perturbations hormonales comme l'insuffisance corticotrope, avec un impact possible sur le pronostic
, Methods: Patients with non-severe SAH (WFNS grade ?3) were included. Hormonal assays were collected in the first 48 hours: baseline and stimulated cortisol (after 250 µg of Synacthene®) and ACTH. CIRCI was defined by a random total cortisol of < 100 ng/ml or a ? cortisol of < 90 ng/ml. Patients were followed for 30 days with identification of complications: vasospasm, delayed cerebral ischemia, rebleeding, seizure, hydrocephalus and infection. After 30 days, Glasgow outcome scale (GOS), modified Rankin scale (mRS) and the Short Form-12 (SF-12) were assessed by phone conversation. Results: 52 patients were included from, Critical Illness -Related Corticosteroïd Insufficiency after Non-severe Acute Aneurysmal Subarachnoid Haemorrhage: Impact on complications and early outcome Introduction: Aneurysmal subarachnoid haemorrhage (ASAH) is a life threatening condition that may be aggravated by hormonal disturbances such as critical illness-related corticosteroid insufficiency (CIRCI), 2013.
Anesthésie -Réanimation / Epidémiologie Mots-clés: hémorragie sous-arachnoïdienne / insuffisance corticotrope / complications / pronostic fonctionnel Key words: non severe aneurysmal subarachnoid haemorrhage / critical illness-related corticosteroid insufficiency / complications / outcome Jury: Président: Monsieur le Professeur SEGUIN Philippe Assesseurs: Madame le Professeur Beloeil Hélène (directeur de thèse) Messieurs les ,