Prevalence of Pituitary Deficiency in Patients after Aneurysmal Subarachnoid Hemorrhage

Abstract

After aneurysmal subarachnoid hemorrhage (SAH), patients frequently present with persistent bodily, psychosocial, and cognitive impairments that resemble those of patients with untreated partial or complete pituitary insufficiency. Because of these similarities, the authors hypothesized that aneurysmal SAH may cause pituitary dysfunction. Pituitary function testing was performed in 40 aneurysmal SAH patients between 12 and 72 months after the SAH. A combined TRH-LHRH-arginine test and the insulin tolerance test were performed on two separate days. Only 18 of 40 (45%) of the tested patients had normal pituitary function. Five of 40 exhibited isolated severe GH deficiency (GHD), and an additional three of 40 had severe GHD plus corticotroph deficiency. Isolated corticotroph deficiency was seen in 13 of 40 patients, and one patient showed isolated thyrotroph deficiency. All but one patient with corticotroph insufficiency were female. Patients with severe GHD had gained significantly more weight since their SAH than patients without GHD and exhibited a significantly higher body mass index. None of the clinical parameters indicative of a poor neurological outcome in aneurysmal SAH were related to pituitary insufficiency. In summary, neuroendocrine dysfunction was identified in a substantial portion of patients with previous aneurysmal SAH and should be borne in mind as a potential long-term sequel of the illness.

Hypothalamic–pituitary insufficiency following infectious diseases of the central nervous system

“…On the contrary, there were a substantial number of isolated corticotropic deficiencies. With these findings, we are in concordance with Kreitschmann-Andermahr et al (10), who found a high incidence of isolated corticotropic deficiencies in patients with previous SAH. Contrary to their data, in our present study, other anterior pituitary deficits despite two borderline gonadotropic deficiencies were not seen, especially no somatotropic deficiencies and no differences in body composition.…”

“…In our investigation, PRL concentrations were within the normal ranges in all patients. However, the presence of an isolated corticotropic deficiency has been taken as a hint for a hypothalamic rather than a pituitary damage (10). The site of the endocrine dysfunction and the reason for the predominance of isolated corticotropic insufficiency remain speculative.…”

“…A delay in diagnosis of months to years was common (2,3). Since then, several studies evaluating the rate and risk factors of hypothalamic-pituitary dysfunction after TBI and SAH have been conducted (4)(5)(6)(7)(8)(9)(10).…”

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

“…Our rate of vasospasm was lower than Lammert et al and comparable to Klose et al; however, we had the greatest proportion of patients treated by endovascular coiling which may have been a significant factor. Kreitschmann-Andermahr et al (31) had speculated that open surgery may be associated with a higher incidence of hypopituitarism, and Bellebaum et al (32) had found a higher incidence of neuropsychological morbidity in patients who underwent clipping vs coiling.…”

Neuroendocrine dysfunction in patients recovering from subarachnoid hemorrhage

“…[1][2][3][4][5][6] Pituitary insufficiency in a patient after SAH caused by the rupture of an aneurysm of the anterior communicating artery was published in 1961 by Hoff et al 7 Kelly and colleagues reported pituitary insufficiency after SAH in two patients 3.5 and 13 months, respectively, after aneurysmal SAH. 1 These patients presented with Growth Hormone Deficiency (GHD) diagnosed by Insulin Tolerance Test (ITT).…”