Year: 2026 | Month: February | Volume: 16 | Issue: 2 | Pages: 341-349
DOI: https://doi.org/10.52403/ijhsr.20260238
Stress Biomarkers in Acute Stroke: Cortisol as a Prognostic Indicator
Isha Atam1, Shraddha Singh1, Satish Kumar2, Nikhil Gupta2
1Department of Physiology, 2Department of Internal Medicine,
King George’s Medical University, Lucknow, India.
Corresponding Author: Dr. Isha Atam
ABSTRACT
Acute ischemic stroke (AIS) provokes a significant systemic stress response marked by activation of the hypothalamic–pituitary–adrenal (HPA) axis and sympathetic nervous system, resulting in elevated cortisol levels. Cortisol, the primary glucocorticoid hormone, regulates metabolic, immune, vascular, and neuronal functions during stress. While initially adaptive, excessive or sustained hypercortisolemia in AIS may contribute to secondary brain injury and unfavorable clinical outcomes.
Elevated cortisol promotes gluconeogenesis and insulin resistance, leading to stress hyperglycemia, which is associated with larger infarct size, blood–brain barrier disruption, and poorer neurological recovery. Cortisol also exerts immunosuppressive effects, reducing lymphocyte activity and altering cytokine balance, thereby increasing susceptibility to post-stroke infections such as pneumonia. Additionally, cortisol may impair endothelial function, increase oxidative stress, and disrupt cerebral autoregulation, further aggravating ischemic damage. At the neuronal level, excessive glucocorticoid exposure has been linked to excitotoxicity, mitochondrial dysfunction, and apoptosis.
Clinical studies consistently demonstrate that higher cortisol levels during the acute phase correlate with greater stroke severity, larger infarct volumes, increased complications, and poorer functional outcomes, including higher short-term mortality. Both serum and salivary cortisol have been explored as prognostic biomarkers; however, variability in sampling timing, circadian influences, and assay methods limits standardization.
Cortisol likely serves both as a marker of stroke severity and a mediator of secondary injury. Although promising as a prognostic indicator, further research is needed to clarify its causal role and therapeutic implications in AIS management.
Key words: Acute ischemic stroke, cortisol, HPA axis, stress biomarkers, prognosis, neuroendocrine response