Pituitary deficiency after aneurysmal subarachnoid hemorrhage

Abstract

OBJECTIVE:Aneurysmal subarachnoid hemorrhage puts patients at high risk for the development of pituitary insufficiency. We evaluated the incidence of pituitary dysfunction in these patients and its correlation with clinical outcome.METHODS:Pituitary function was tested in 66 consecutive patients in the first 15 days after aneurysmal subarachnoid hemorrhage. The following were measured in all patients: thyroid-stimulating hormone, free thyroxine, triiodothyronine, luteinizing hormone, follicle-stimulating hormone, total testosterone (in males), estradiol (in females), prolactin, serum cortisol, plasma adrenocorticotropic hormone, growth hormone and insulin growth factor.RESULTS:The endocrine assessment was made at a mean of 7.4 days (standard deviation ±6.6) after subarachnoid hemorrhage. Forty-four (66.7%) female and 22 (33.3%) male patients were evaluated. Thirty-nine patients (59.1%) had some type of pituitary dysfunction. Follicle-stimulating hormone/luteinizing hormone deficiency was the most frequent disorder (34.8%), followed by growth hormone/insulin growth factor (28.7%), adrenocorticotropic hormone (18.1%) and thyroid-stimulating hormone (9%). Seventeen (25.7%) patients showed deficiencies in more than one axis. A greater incidence of hormone deficiency was observed in patients with a Glasgow Coma Scale score ≤13 (t test, p = 0.008), Hunt-Hess grade ≥4 (t test, p<0.001), or Fisher grade 4 (t test, p = 0.039). Hormone deficiency was not significantly associated (p>0.05) with increased hospitalization or clinical outcome.CONCLUSION:Pituitary dysfunction was identified in a substantial portion of patients with previous aneurysmal subarachnoid hemorrhage, but no association was found between this dysfunction and poor clinical outcome.

Clinical prevalence and outcome impact of pituitary dysfunction after aneurysmal subarachnoid hemorrhage: a systematic review with meta-analysis

“…Schneider et al [37] analyzed data collected using a structured, internet-based study sheet about a total of 1242 patients (825 TBI and 417 SAH), and they found that TBI patients with endocrinological alterations had worse GOS compared to TBI patients who did not develop hypopituitarism (p = 0.032); however, they did not find any significant differences in terms of outcome (GOS) among SAH patients population (p [ 0.05). Similar results were described by Pereira et al [15] who demonstrated that hormone deficiency is not significantly associated (p = 0.05) with increased hospitalization or clinical outcome. In opposition, some authors found a significant association between pituitary dysfunction and patients' outcome [11,13]: Lammert et al [24] demonstrated that all patients with neuro-endocrine dysfunction presented impaired clinical outcome (p value = 0.007) and Poll et al [28] found that patients with normal diurnal free serum cortisol had a significantly shorter ICUstay, less complications, and a more favorable outcome (p value = 0.051).…”

“…However, the studies addressing this issue are few and based on small patient cohorts [9-11, 13, 14]. Some are focused on the acute phase of aSAH [13,15], others on the chronic phase of aSAH [16,17], while some adress both [10,18]. There is substantial heterogeniety in the conclusions of these studies: although some suggest that hypopituitarism after aSAH affects only exceptional cases [19,20], others describe a high incidence reaching up to 50 % of cases [9,11,14].…”

“…We also separately noted the percentage of endocrine abnormalities detected during the acute and chronic phase after SAH. The ''acute phase'' was defined as the occurrence of pituitary dysfunction within the first 6 months after aSAH, and the ''chronic phase'' included endocrine dysfunction occurring after 6 months from aSAH, as suggested by the authors [10][11][12][13][14][15][16][17][18].…”

Acute hormonal findings after aneurysmal subarachnoid hemorrhage – report from a single center

“…Furthermore, there was no association between aneurysm location and hormone levels, which is in accordance with others (10). Our results regarding the outcome are not in line with previous studies, which have observed correlations with worse clinical status and outcome with other hormonal abnormalities (17)(18)(19). Dopamine (20,21) and etomidate (22) are known to have effect on hormone secretion but the observed hormone abnormalities in our study were not attributed to them as dopamine or etomidate were not used in any of our patients.…”

Impact of pituitary dysfunction on cognitive and global outcome after traumatic brain injury and aneurysmal subarachnoid haemorrhage

“…Low gonadotrophins had a significant negative association with GOSE, but not with BNIS or RLAS-R. This finding is in agreement with the results of several previous studies reporting on the impact of multiple hormone dysfunctions, including the gonadotrophic axis, such as studies of patients with aSAH (32)(33)(34) and patients with both TBI and aSAH (35), all reporting worse outcome, as measured by GOS. One previous study by Marina et al (30) also used GOSE and observed a negative impact of low gonadotrophins in patients with TBI.…”