Pituitary dysfunction in survivors of spontaneous subarachnoid hemorrhage of anterior communicating artery and middle cerebral artery aneurysms: A comparative study

ObjectiveWe describe the occurrence and course of anterior pituitary dysfunction (PD) after aneurysmal subarachnoid haemorrhage (SAH), and identify clinical determinants for PD in patients with recent SAH.MethodsWe prospectively collected demographic and clinical parameters of consecutive survivors of SAH and measured fasting state endocrine function at baseline, 6 and 14 months. We included dynamic tests for growth-hormone function. We used logistic regression analysis to compare demographic and clinical characteristics of patients with SAH with and without PD.Results84 patients with a mean age of 55.8 (±11.9) were included. Thirty-three patients (39%) had PD in one or more axes at baseline, 22 (26%) after 6 months and 6 (7%) after 14 months. Gonadotropin deficiency in 29 (34%) patients and growth hormone deficiency (GHD) in 26 (31%) patients were the most common deficiencies. PD persisted until 14 months in 6 (8%) patients: GHD in 5 (6%) patients and gonadotropin deficiency in 4 (5%). Occurrence of a SAH-related complication was associated with PD at baseline (OR 2.6, CI 2.2 to 3.0). Hydrocephalus was an independent predictor of PD 6 months after SAH (OR 3.3 CI 2.7 to 3.8). PD was associated with a lower score on health-related quality of life at baseline (p=0.06), but not at 6 and 14 months.ConclusionsAlmost 40% of SAH survivors have PD. In a small but substantial proportion of patients GHD or gonadotropin deficiency persists over time. Hydrocephalus is independently associated with PD 6 months after SAH.Trial registration numberNTR 2085.

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“… 6 7 In some studies, patients were selected on the basis of symptoms of fatigue 14 or on location of the aneurysm. 15 …”

Section: Introductionmentioning

confidence: 99%

Pituitary dysfunction after aneurysmal subarachnoid haemorrhage: course and clinical predictors—the HIPS study

Khajeh

Blijdorp

Heijenbrok‐Kal

et al. 2014

J Neurol Neurosurg Psychiatry

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“…Dutta et al evaluated endocrine function in 60 SAH patients with anterior communicating artery (A-com) and middle cerebral artery (MCA) aneurysms using only basal hormonal tests. Part of the study was retrospective, analysing patients one year after SAH and partly prospectively analysing patients 6 months after SAH [ 46 ]. Kronvall et al prospectively analysed 45 patients in the acute phase and 3 to 6 months after SAH, using basal hormonal test and GHRH-arg test for GHD.…”

Section: Resultsmentioning

confidence: 99%

“…Blijdorp et al prospectively analysed 84 patients and reported preliminary data of 43 patients using basal hormonal tests, synacten test when ACTH deficiency was suspected and a ghrelin test in the early phase after SAH and confirmatory GHRH-arg test after six months [ 42 ]. The most prominent methodological shortcomings were the incomplete reports of patient selection [ 17 , 32 , 33 , 35 , 37 , 46 ], selection bias [ 17 , 33 - 35 , 42 , 46 ] and inadequate laboratory testing [ 17 , 33 , 35 , 36 , 38 , 43 , 44 ]. Some studies did not use dynamic tests to determine growth hormone or corticotrophin deficiency [ 17 , 34 , 43 , 44 , 46 ].…”

Section: Resultsmentioning

confidence: 99%

“…Basal concentrations alone are not always distinctive, because of pulsatile, circadian or situational secretion. This may have led to misinterpretations of hormone values in some of the studies [ 17 , 34 , 46 ]. The assessment of ACTH and GH requires dynamic tests to reliably detect deficiency of these hormones [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…The assessment of ACTH and GH requires dynamic tests to reliably detect deficiency of these hormones [ 19 ]. Dynamic tests were not performed in three of the studies [ 17 , 34 , 46 ] and in some studies the tests conducted even varied within the cohort [ 33 , 36 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

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Hypopituitarism after subarachnoid haemorrhage, do we know enough?

et al. 2014

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BackgroundFatigue, slowness, apathy and decrease in level of activity are common long-term complaints after a subarachnoid haemorrhage (SAH). They resemble the symptoms frequently found in patients with endocrine dysfunction. Pituitary dysfunction may be the result of SAH or its complications. We therefore hypothesized that it may explain some of the long-term complaints after SAH.We reviewed the literature to clarify the occurrence, pattern and severity of endocrine abnormalities and we attempted to identify risk factors for hypopituitarism after SAH. We also assessed the effect of hypopituitarism on long-term functional recovery after SAH.MethodsIn a MEDLINE search for studies published between 1995 and 2014, we used the term subarachnoid haemorrhage in combination with pituitary, hypopituitarism, growth hormone, gonadotropin, testosterone, cortisol function, thyroid function and diabetes insipidus. We selected all case-series and cohort studies reporting endocrine function at least 3 months after SAH and studied their reported prevalence, pathogenesis, risk factors, clinical course and outcome.ResultsWe identified 16 studies describing pituitary function in the long term after SAH. The reported prevalence of endocrine dysfunction varied from 0 to 55% and the affected pituitary axes differed between studies. Due to methodological issues no inferences on risk factors, course and outcome could be made.ConclusionsNeuroendocrine dysfunction may be an important and modifiable determinant of poor functional outcome after SAH. There is an urgent need for well-designed prospective studies to more precisely assess its incidence, clinical course and effect on mood, behaviour and quality of life.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-014-0205-0) contains supplementary material, which is available to authorized users.

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

et al. 2016

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Pituitary dysfunction in survivors of spontaneous subarachnoid hemorrhage of anterior communicating artery and middle cerebral artery aneurysms: A comparative study

Abstract: Hormonal deficiencies are not uncommon in patients with SAH. There is no difference in hormonal deficiencies and severity of hypopituitarism in patients with SAH due to A-com and MCA bleed.

Cited by 12 publications

References 17 publications

Pituitary dysfunction after aneurysmal subarachnoid haemorrhage: course and clinical predictors—the HIPS study

Pituitary dysfunction after aneurysmal subarachnoid haemorrhage: course and clinical predictors—the HIPS study

Hypopituitarism after subarachnoid haemorrhage, do we know enough?

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

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