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

Abstract

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.

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

“…This was also found to be the case in the 12 month post-SAH evaluation by Gardner et al [16] The strength of our study is the prospective design, the broad endocrine evaluation and the correlation of endocrine disturbances to clinical characteristics of SAH.…”

“…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. The German Database on Hypopituitarism after Traumatic Brain Injury and Aneurysmal Subarachnoid Hemorrhage has also revealed a similar incidence of pituitary dysfunction.…”

GH deficiency after traumatic brain injury: improvement in quality of life with GH therapy: analysis of the KIMS database

“…Furthermore, results of several dynamic function tests are dependent on the BMI of the patient (23), therefore confounding the data.…”

Early endocrine alterations reflect prolonged stress and relate to 1-year functional outcome in patients with severe brain injury

“…Both TBI and non-TBI may be complicated by short-and long-term pituitary dysfunction, which has possible implications for the recovery and functional outcomes of patients (3). The reported prevalence of acute and chronic chronic subdural haematoma (12) and ischaemic stroke (13), have been related to an increased prevalence of hypopituitarism in some studies but not in others (14,15).…”