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

Takala, Riikka; Kiviranta, Riku; Olkkola, Klaus T.; Vahlberg, Tero; Laukka, Dan; Kotkansalo, Anna; Rahi, Melissa; Sankinen, Matti; Posti, Jussi P.; Katila, Ari; Rinne, Jaakko

doi:10.1080/07435800.2016.1242603

Cited by 1 publication

(1 citation statement)

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“…These three prospective studies are relatively small, with analysis of cortisol dynamics taking place at only a single time point. In a prospective cohort study of 100 patients after SAH, serial measurements of 09:00-h plasma cortisol for twelve days after haemorrhage demonstrated a rate of ACTH/cortisol deficiency of 14% based on a cut-off of 300 nmol/L (71), whereas a recent prospective study by Takala reported a rate of 11% based on a cut-off of 276 nmol/L on six measurements over fourteen days (72). Importantly, Hannon's data showed that ACTH deficiency is often transient after SAH; therefore, a single estimation of plasma cortisol at one time point may miss the diagnosis.…”

Section: Anterior Pituitarymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Neuroendocrine surveillance and management of neurosurgical patients

Garrahy

Sherlock

Thompson

2017

European Journal of Endocrinology

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Advances in the management of traumatic brain injury, subarachnoid haemorrhage and intracranial tumours have led to improved survival rates and an increased focus on quality of life of survivors. Endocrine sequelae of the acute brain insult and subsequent neurosurgery, peri-operative fluid administration and/or cranial irradiation are now well described. Unrecognised acute hypopituitarism, particularly ACTH/cortisol deficiency and diabetes insipidus, can be life threatening. Although hypopituitarism may be transient, up to 30% of survivors of TBI have chronic hypopituitarism, which can diminish quality of life and hamper rehabilitation. Patients who survive SAH may also develop hypopituitarism, though it is less common than after TBI. The growth hormone axis is most frequently affected. There is also accumulating evidence that survivors of intracranial malignancy, who have required cranial irradiation, may develop hypopituitarism. The time course of the development of hormone deficits is varied, and predictors of pituitary dysfunction are unreliable. Furthermore, diagnosis of GH and ACTH deficiency require dynamic testing that can be resource intensive. Thus the surveillance and management of neuroendocrine dysfunction in neurosurgical patients poses significant logistic challenges to endocrine services. However, diagnosis and management of pituitary dysfunction can be rewarding. Appropriate hormone replacement can improve quality of life, prevent complications such as muscle atrophy, infection and osteoporosis and improve engagement with physiotherapy and rehabilitation.

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Section: Anterior Pituitarymentioning

confidence: 99%