cosyntropin and Brain-Edema

Topics: Adrenocorticotropic Hormone; Aged; Brain Edema; Cerebral Infarction; Cosyntropin; Glycerol; Humans; Methylprednisolone; Middle Aged; Spironolactone

Glucocorticoids are the main drug used to control vasogenic edema in patients with brain tumor. Rapid GC tapering may not only decompensate intracranial pressure, but also unmask SAI, and some symptoms of SAI can be mistakenly attributable to increased intracranial pressure or side effects of chemotherapy and radiation therapy.. The University of Virginia Neuro-Oncology Database was reviewed from February 2002 to January 2006, and 5 neuro-oncology patients with clinical and laboratory evidence of SAI were identified.. In our experience, 1% of neuro-oncology patients treated with GC developed SAI. Symptoms resembled increased intracranial pressure or side effects of antineoplastic treatment.. A healthy index of suspicion for this complication and use of pharmacologic testing will help avert misattribution of symptoms of SAI and its deleterious consequences.

Topics: Adrenal Insufficiency; Adrenocorticotropic Hormone; Adult; Aged; Brain Edema; Brain Neoplasms; Causality; Cosyntropin; Drug Administration Schedule; Female; Glucocorticoids; Humans; Hypothalamo-Hypophyseal System; Intracranial Hypertension; Male; Middle Aged; Patient Selection; Substance Withdrawal Syndrome

Tetracosactide is known to be used in brain tumours, but its action is difficult to evaluate clearly. Tetracosactide exerts analgesic, anti-emetic and anti-inflammatory effects and it reduces the oedema surrounding brain tumours. It is this latter effect which we have studied. We used a technetium-labelled cerebral marker, 99mTc HMPAO (Ceretec), and found that this functional exploration not only detects the presence of a brain tumour, but also measures regional cerebral blood flow. This marker is mainly used in intracerebral vascular diseases. Since february 1990, eighteen patients suffering from malignant brain tumour with pronounced perilesional oedema were selected and treated with tetracosactide for two days. With the help of 99mTc HMPAO scintigraphy the oedema was quantified, and the results obtained were interpreted. The initial results of this clinical experiment indicate that the phenomena observed were due to improved vascularization of the healthy peritumoral areas with resorption of oedema. This was a consequence of the direct tetracosactide action, and the higher the dose of this compound, the clearer its action.

Topics: Adult; Aged; Brain; Brain Edema; Brain Neoplasms; Cosyntropin; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Time Factors; Tomography, X-Ray Computed

The anti-oedematous effect of tetracosactide (Synacthene Immediate) was studied on a rat brain transient global ischaemia model. Brain oedema was evaluated by proton nuclear magnetic resonance, with measurement of T1 and T2 relaxation times in the cortex and white matter. The effective kinetic dose of tetracosactide was 0.4 mg/kg, and a comparison of the results obtained with those observed after treatment with dexamethasone 13 mg/kg confirmed that both drugs may be regarded as potent anti-oedematous agents, but there was nothing in this study to suggest that the mechanism of action of tetracosactide was different from that of corticosteroids.

Topics: Animals; Brain Edema; Cosyntropin; Dexamethasone; Dose-Response Relationship, Drug; Ischemic Attack, Transient; Magnetic Resonance Imaging; Male; Rats; Rats, Inbred Strains

Cerebral oedema, present or potential, is a predominant medical complication of neurosurgery. Its physiopathology and treatment can be in part linked to adrenal activity (aldosterone and sodium balance; cortisol and hormone treatments). In 25 non-comatose patients presenting with a tumoral or vascular neurosurgical condition, plasma cortisol and aldosterone levels were measured by radioimmunoassay, always at the same time (07 h), before any investigations or treatment were carried out, the patient being at rest. Cortisol levels were increased in more than half the patients (n = 14; 44.11 +/- 3.4 micrograms X 100 ml-1; p less than 0.001); aldosterone levels were high in one third of the patients (n = 8; 304.29 +/- 57 micrograms X ml-1; p less than 0.001). 17 of these patients were studied according to the protocol of the synthetic ACTH test during the first four days of their receiving 1 mg X 24 h-1 synthetic ACTH. The expected therapeutic effect on cortisol was not obtained in all cases, and the stimulation of aldosterone release was important and prolonged.

Topics: Adrenocorticotropic Hormone; Adult; Aged; Aldosterone; Brain Edema; Cosyntropin; Female; Humans; Hydrocortisone; Male; Middle Aged; Nervous System Diseases; Neurosurgery