Department of Internal Medicine, Medical Faculty P.J. Šafárik University Košice, Slovakia.
Department of Internal medicine 4, Medical faculty, P.J. Šafárik University, Košice, Slovakia.
Auton Neurosci. 2024 Aug;254:103196. doi: 10.1016/j.autneu.2024.103196. Epub 2024 Jun 27.
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).
Case-control study on patients with VVS and healthy controls.
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.
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.
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.
晕厥是由于大脑灌注不足导致的短暂意识丧失。血管迷走性晕厥（VVS）是一种直立不耐受（OI）形式。其头晕和低血压等临床体征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合成促肾上腺皮质激素（ACTH）刺激后的肾上腺功能。
血管迷走性晕厥患者与健康对照的病例对照研究。
该研究共纳入 42 名参与者，包括 27 名经直立倾斜试验诊断为 VVS 的患者和 15 名无晕厥或任何直立症状史的健康个体。在基础状态下以及肌肉内注射 ACTH 刺激后 30 和 60 分钟时测量血清皮质醇和醛固酮浓度。
VVS 患者的基础皮质醇水平显著升高（441±143 比 331±84.7 nmol/L，p=0.01），ACTH 刺激后 30 分钟（802±143 比 686±105 nmol/L，p=0.01）和 60 分钟（931±141 nmol/L 比 793±147 nmol/L，p=0.001）时皮质醇水平也显著升高（Synacthen 250μg）。血浆醛固酮在 ACTH 刺激后增加，但组间无显著差异。此外，皮质醇水平与血压或心率之间也无显著相关性。
诊断为 VVS 的患者在基础状态和 ACTH 刺激后皮质醇水平均升高。这一发现表明，VVS 患者的肾上腺皮质活动较高，可能是对晕厥引起的直立应激的反应，这对自主神经系统起到应激刺激作用。
