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

Robba, Chiara; Bacigaluppi, Susanna; Bragazzi, Nicola Luigi; Lavinio, Andrea; Gurnell, Mark; Bilotta, Federico; Menon, David

doi:10.1007/s11102-016-0733-2

Cited by 22 publications

(36 citation statements)

References 67 publications

(104 reference statements)

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“…In the present study, we observed higher HCCs in the aSAH group. Accordingly, the present data are at odds with studies showing that patients with aSAH have suffered from hypopituitarism [14,36] and tended to have a lower morning overall cortisol output [16]. However, previous studies have also shown that compared to healthy controls, aSAH patients had a higher CAR as measured by the AUCi [16].…”

Section: Discussioncontrasting

confidence: 73%

“…However, our findings add to the existing literature by providing preliminary evidence that high HCC levels can be used as a biomarker for poor psychological functioning among aSAH populations. This finding is important as researchers were not able to correlate assessments of pituitary hormone dysregulation with the outcomes of aSAH patients in previous studies [36]. …”

Section: Discussionmentioning

confidence: 96%

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In Individuals Following Aneurysmal Subarachnoid Haemorrhage, Hair Cortisol Concentrations Are Higher and More Strongly Associated with Psychological Functioning and Sleep Complaints than in Healthy Controls

Colledge

Brand²,

Zimmerer³

et al. 2017

Neuropsychobiology

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Background: Following an aneurysmal subarachnoid haemorrhage (aSAH), many patients report persistent deficits in psychological functioning, characterised by high levels of stress and symptoms of depression, low life satisfaction, along with poor sleep. Such deficits have been associated with altered saliva and serum cortisol levels due to a dysregulation of hypothalamic-pituitary-adrenal axis activity (HPA-AA). However, hair cortisol concentrations (HCCs) have not been assessed in this population, although this method allows a long-term insight into cortisol values. Therefore, the objective of this study was to compare HCCs in aSAH patients and healthy controls and to examine how HCCs are associated with perceived stress, psychological functioning, and sleep complaints. Methods: In this cross-sectional study, data on depressive symptoms, hypochondriacal beliefs, life satisfaction, and sleep complaints were gathered in 15 aSAH patients and 17 healthy controls. HCCs of the previous 3 months were assessed. Results: aSAH patients had significantly higher HCCs than healthy controls. In aSAH patients, higher HCCs were significantly associated with increased depressive symptoms, hypochondriacal beliefs, lower life satisfaction, and increased sleep complaints. Such significant associations were not found in healthy controls. Conclusions: Our findings indicate that a dysregulation of HPA-AA is associated with some of the long-term impairments in psychological functioning and sleep in aSAH survivors. While the direction of association remained unclear, a dysregulated HPA-AA may be causally linked with the maintenance of poor psychological functioning and poor sleep. The overall findings should be considered in the planning of long-term treatment aimed at improving psychological functioning and sleep in aSAH patients.

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Section: Discussioncontrasting

confidence: 73%

Section: Discussionmentioning

confidence: 96%

In Individuals Following Aneurysmal Subarachnoid Haemorrhage, Hair Cortisol Concentrations Are Higher and More Strongly Associated with Psychological Functioning and Sleep Complaints than in Healthy Controls

Colledge

Brand²,

Zimmerer³

et al. 2017

Neuropsychobiology

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“…Subarachnoid hemorrhage (SAH) is an important cause of morbidity and mortality, and there is evidence that SAH may adversely affect pituitary function in both the acute and chronic phases (30,31). The prevalence of endocrine dysfunction caused by SAH ranges from 0 to 55% (31,32).…”

Section: Subarachnoid Hemorrhage (Sah)mentioning

confidence: 99%

“…The prevalence of endocrine dysfunction caused by SAH ranges from 0 to 55% (31,32). Isolated pituitary hormone deficiencies are more frequently found than multiple.…”

Section: Subarachnoid Hemorrhage (Sah)mentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Expanding the cause of hypopituitarism

Pekić

Popović

2017

European Journal of Endocrinology

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Hypopituitarism is defined as one or more pituitary hormone deficits due to a lesion in the hypothalamic-pituitary region. By far, the most common cause of hypopituitarism associated with a sellar mass is a pituitary adenoma. A high index of suspicion is required for diagnosing hypopituitarism in several other conditions such as other massess in the sellar and parasellar region, brain damage caused by radiation and by traumatic brain injury, vascular lesions, infiltrative/immunological/inflammatory diseases (lymphocytic hypophysitis, sarcoidosis and hemochromatosis), infectious diseases and genetic disorders. Hypopituitarism may be permanent and progressive with sequential pattern of hormone deficiencies (radiation-induced hypopituitarism) or transient after traumatic brain injury with possible recovery occurring years from the initial event. In recent years, there is increased reporting of less common and less reported causes of hypopituitarism with its delayed diagnosis. The aim of this review is to summarize the published data and to allow earlier identification of populations at risk of hypopituitarism as optimal hormonal replacement may significantly improve their quality of life and life expectancy.Correspondence should be addressed to V Popovic

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“…While it is well known that the bleeding itself and hospital complications substantially contribute to these deficits [2,3], early identification of patients at high risk remains difficult. Some of the typical neuropsychological deficits after SAH resemble clinical symptoms of hypopituitarism [4], which is commonly observed in the acute and subacute phase after SAH [5][6][7][8]. Potential pathophysiological mechanisms resulting in endocrine dysfunction include direct compression of the hypothalamic-pituitary complex by the aneurysm itself, intracranial hypertension, compromised perfusion during initial circulatory arrest after SAH with subsequent ischemic injury, hydrocephalus, and iatrogenic causes through pharmacological treatment or procedure related injuries [5,9].…”

Section: Introductionmentioning

confidence: 99%

Subarachnoid Hemorrhage is Followed by Pituitary Gland Volume Loss: A Volumetric MRI Observational Study

et al. 2019

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Background: Subarachnoid hemorrhage (SAH) is a devastating disease associated with high mortality and morbidity. Besides neurological sequelae, neuropsychological deficits largely contribute to patients' long-term quality of life. Little is known about the pituitary gland volume (PGV) after SAH compared to healthy referents and the association of PGV with long-term outcome including cognitive function.Methods: Sixty consecutive non-traumatic SAH patients admitted to the neurological intensive care unit between 2010 and 2014 were enrolled. 3-Tesla magnetic resonance imagining was performed at baseline (16 days) and 12 months after SAH to measure PGV semi-automatically using the software iPlan Net 3.5.0. PGV was compared to age and sex matched healthy referents. The difference between baseline and 1-year-PGV was classified as increase (> 20 mm 3 PGV increase), stable (± 20 mm 3 ), or decrease (> 20 mm 3 PGV decrease). In addition, total intracerebral volume was calculated. Neuropsychological testing was applied in 43 SAH patients at 1-year follow up encompassing several domains (executive, attention, memory) and self-assessment (questionnaire for self-perceived deficits in attention [German: FEDA]) of distractibility in mental processes, fatigue and decrease in motivation. Multivariable regression with multivariable generalized linear models was used for comparison of PGVs and for subgroup analysis to evaluate a potential association between PGV and neuropsychological outcome. Results: Patients were 53 years old (IQR = 44-63) and presented with a median Hunt&Hess grade of 2 (IQR = 1-3). SAH patients had a significantly lower PGV both at baseline (360 ± 19 mm 3 , p < 0.001) and 1 year (367 ± 18 mm 3 p < 0.001) as compared to matched referents (mean 505 ± 18 mm 3 ). PGV decreased by 75 ± 8 mm 3 in 28 patients, increased by 120 ± 22 mm 3 in 22 patients and remained stable in 10 patients at 1-year follow-up. PGV in patients with PGV increase at 12 months was not different to healthy referents (p = 0.062). Low baseline PGV was associated with impaired executive functions at 1 year (adjOR = 8.81, 95%-CI = 1.46-53.10, p = 0.018) and PGV decrease within 1 year was associated with self-perceived worse motivation (FEDA; Wald-statistic = 6.6, df = 1, p = 0.010).

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

Cited by 22 publications

References 67 publications

In Individuals Following Aneurysmal Subarachnoid Haemorrhage, Hair Cortisol Concentrations Are Higher and More Strongly Associated with Psychological Functioning and Sleep Complaints than in Healthy Controls

In Individuals Following Aneurysmal Subarachnoid Haemorrhage, Hair Cortisol Concentrations Are Higher and More Strongly Associated with Psychological Functioning and Sleep Complaints than in Healthy Controls

DIAGNOSIS OF ENDOCRINE DISEASE: Expanding the cause of hypopituitarism

Subarachnoid Hemorrhage is Followed by Pituitary Gland Volume Loss: A Volumetric MRI Observational Study

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