High risk of pituitary dysfunction due to aneurysmal subarachnoid haemorrhage: a prospective investigation of anterior pituitary function in the acute phase and 12 months after the event

Tanrıverdi, Fatih; Dagli, Ahmet Turan; Karaca, Züleyha; Ünlühızarcı, Kürşad; Selçuklu, Ahmet; Casanueva, Felipe F.; Keleştimur, Fahrettin

doi:10.1111/j.1365-2265.2007.02989.x

Cited by 56 publications

(99 citation statements)

References 28 publications

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“…This pattern has also been described after traumatic brain injury and has been argued to be a part of a more general response to severe acute illness. [2] Similar findings following SAH with high incidences in the acute stage that later resolves has also been demonstrated by Tanriverdi et al [31] and Klose et al [24] In most cases, pituitary impairments were either new or had resolved at followup compared to the acute stage. Similar findings have also been noted in longitudinal studies by Aimaretti et al, [3] Tanriverdi et al [31] and Karaca et al [23] As stated above, acute phase abnormalities that later resolves may be a transient functional response, but may also represent the restorative capacity of the hypothalamic structures involved.…”

Section: Hormonal Abnormalities After Sah By Axissupporting

confidence: 68%

“…This prevalence of endocrine disturbances is consistent with previous studies by Dimoupolou et al, [10] Kreitschmann-Andermahr et al, [25] Aimaretti et al [3] and Tanriverdi et al [31] (37.5-68.2% prevalence at follow-up), but contrasts to results from Klose et al [24] and Lammert et al [26] who found few or no abnormalities at confirmatory testing. Gardner et al [16] recently reported 12% hypopituitarism in their patient series, however also with nonaneurysmal SAH patients included.…”

Section: Discussioncontrasting

confidence: 53%

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Pituitary Dysfunction After Aneurysmal Subarachnoid Hemorrhage Is Associated with Impaired Early Outcome

et al. 2014

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Section: Hormonal Abnormalities After Sah By Axissupporting

confidence: 68%

Section: Discussioncontrasting

confidence: 53%

Pituitary Dysfunction After Aneurysmal Subarachnoid Hemorrhage Is Associated with Impaired Early Outcome

et al. 2014

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“…In the current study, comparable results were obtained regarding the cognition of patients with aSAH, with 52/135 subjects exhibiting cognitive dysfunction (38.52%). Previous studies have demonstrated that patients with aSAH exhibit pituitary hormone deficiencies in the acute and chronic stages, including deficits in gonadotrophin, somatotropin and T4 (18)(19)(20)(21)(22). In the present study, 31 subjects exhibited hypothyroidism, with elevated levels of TSH and normal levels of FT3, FT4, TT3 and TT4 in the chronic stage.…”

Section: Discussionmentioning

confidence: 51%

Effect of thyroid hormone replacement therapy on cognition in long-term survivors of aneurysmal subarachnoid hemorrhage

Yang

Yin

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. Aneurysmal subarachnoid hemorrhage (aSAH) is a recently identified risk factor for chronic hypothyroidism. Patients with hypothyroidism often exhibit cognitive dysfunction. The aim of the present study was to determine the effects of thyroid hormone replacement therapy on cognition in aSAH survivors with hypothyroidism. A study population of 135 patients was recruited and subjected to the Montreal Cognitive Assessment (MoCA) and Beck Depression Inventory. Among the study population, 52 patients exhibited cognitive dysfunction. Thyroid hormone levels were measured in these patients using an electrochemiluminescence immunoassay in order to elucidate possible deficits in the thyrotrophic hormonal axes, and hypothyroidism was confirmed in 31 patients. Among these 31 patients, 22 patients consented to be randomized into groups and were administered levothyroxine replacement or a placebo treatment for 3 months. The MoCA and Wechsler Adult Intelligence Scale-Chinese version (WAIS-RC) testing were performed prior to and following the replacement therapy or placebo treatments. All subjects completed the study with no negative side effects. After 8-12 weeks of oral levothyroxine administration, it was observed that the serum concentration of thyroid-stimulating hormone was restored to normal levels. Furthermore, neuropsychological test results improved following the replacement therapy. A significant improvement was observed in the MoCA scores of the replacement group following therapy, with the exception of the score for abstraction. Additionally, significant improvements in the WAIS-RC were observed in the replacement group, with the exceptions of the information comprehension and letter-number sequencing scores. Thus, the present study has demonstrated the partial normalization of cognitive impairments in patients with hypothyroidism following aSAH as a result of appropriate levothyroxine replacement therapy.

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“…A number of studies, often incorporating patients with both SAH and traumatic brain injury (TBI), have concluded that hypopituitarism is common in this patient group (1,2,3,4,5), with a systematic review by Schneider et al in 2007 (6) concluding that hypopituitarism is present in 47% of patients in the chronic phase after SAH. In contrast, Klose et al (7), evaluating 61 patients prospectively, concluded that SAH was uncommon having failed to identify a single case.…”

Section: Introductionmentioning

confidence: 99%

Low prevalence of hypopituitarism after subarachnoid haemorrhage using confirmatory testing and with BMI-specific GH cut-off levels

Gardner

Javadpour

Stoneley

et al. 2013

European Journal of Endocrinology

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Objective: Hypopituitarism following subarachnoid haemorrhage (SAH) has been reported to be a frequent occurrence. However, there is considerable heterogeneity between studies with differing patient populations and treatment modalities and most importantly employing differing endocrine protocols and (normal) reference ranges of GH. We aimed to examine prospectively a cohort of SAH survivors for development of hypopituitarism post-SAH using rigorous endocrine testing and compare GH response to glucagon stimulation with a cohort of healthy controls of a similar BMI. Design and methods: Sixty-four patients were investigated for evidence of hypopituitarism 3 months post-SAH with 50 patients tested again at 12 months. Glucagon stimulation testing (GST), with confirmation of deficiencies by GHRH/arginine testing for GH deficiency (GHD) and short synacthen testing for ACTH deficiency, was used. Basal testing of other hormonal axes was undertaken. Results: Mean age of patients was 53G11.7 years and mean BMI was 27.5G5.7 kg/m 2 . After confirmatory testing, the prevalence of hypopituitarism was 12% (GHD 10%, asymptomatic hypocortisolaemia 2%). There was no association between hypopituitarism and post-SAH vasospasm, presence of cerebral infarction, Fisher grade, or clinical grading at presentation. There was a significant correlation between BMI and peak GH to glucagon stimulation in both patients and controls. Conclusions: Identification of 'true' GHD after SAH requires confirmatory testing with an alternative stimulation test and application of BMI-specific cut-offs. Using such stringent criteria, we found a prevalence of hypopituitarism of 12% in our population.

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High risk of pituitary dysfunction due to aneurysmal subarachnoid haemorrhage: a prospective investigation of anterior pituitary function in the acute phase and 12 months after the event

Abstract: GH deficiency (GHD) was the most common pituitary deficit at 12 months after SAH and the majority of the patients (87.5%) had isolated GHD. During the 12-month follow-up, pituitary function was found to either improve or worsen in a considerable number of patients.

Cited by 56 publications

References 28 publications

Pituitary Dysfunction After Aneurysmal Subarachnoid Hemorrhage Is Associated with Impaired Early Outcome

Pituitary Dysfunction After Aneurysmal Subarachnoid Hemorrhage Is Associated with Impaired Early Outcome

Effect of thyroid hormone replacement therapy on cognition in long-term survivors of aneurysmal subarachnoid hemorrhage

Low prevalence of hypopituitarism after subarachnoid haemorrhage using confirmatory testing and with BMI-specific GH cut-off levels

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