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.

Previous studies about the effects of physical activity and sedentary behaviors on health rarely recorded the exact body postures and movements, although they might be of metabolic relevance. Moreover, few studies treated the time budget of behaviors as compositions and little was done to characterize the distribution of durations of behavior sequences in relation with health. Data from the RECORD (Residential Environment and CORonary heart Disease) study of two combined VitaMove accelerometers worn at the trunk and upper leg for a week by 154 male and female adults (age = 50.6 ± 9.6 years, BMI = 25.8 ± 3.9 kg/m2) were analyzed. Using both iso-temporal substitution and compositional analysis, we examined associations between five physical behaviors (lying, sitting, standing, low physical activity, moderate-to-vigorous activity) and seven health outcomes (fasting serum glucose, low- and high-density lipoprotein, and triglycerides levels, body mass index, and waist circumference). After adjustment for confounding variables, total standing time was positively associated with better lipid profile, and lying during the day with adiposity. No significant association was observed between breaking up moderate-to-vigorous physical activity and health. This study highlights the importance of refined categories of postures in research on physical activity and health, as well as the necessity for new tools to characterize the distribution of behavior sequence durations, considering both bouts and micro-sequences.

ObjectiveTo determine the diagnostic value of a ghrelin test in the diagnosis of GH deficiency (GHD) shortly after aneurysmal subarachnoid hemorrhage (SAH).DesignProspective single-center observational cohort study.MethodsA ghrelin test was assessed after the acute phase of SAH and a GH-releasing hormone (GHRH)–arginine test 6 months post SAH. Primary outcome was the diagnostic value of a ghrelin test compared with the GHRH–arginine test in the diagnosis of GHD. The secondary outcome was to assess the safety of the ghrelin test, including patients' comfort, adverse events, and idiosyncratic reactions.ResultsForty-three survivors of SAH were included (15 males, 35%, mean age 56.6±11.7). Six out of 43 (14%) SAH survivors were diagnosed with GHD by GHRH–arginine test. In GHD subjects, median GH peak during ghrelin test was significantly lower than that of non-GHD subjects (5.4 vs 16.6, P=0.002). Receiver operating characteristics analysis showed an area under the curve of 0.869. A cutoff limit of a GH peak of 15 μg/l corresponded with a sensitivity of 100% and a false-positive rate of 40%. No adverse events or idiosyncratic reactions were observed in subjects undergoing a ghrelin test, except for one subject who reported flushing shortly after ghrelin infusion.ConclusionOwing to its convenience, validity, and safety, the ghrelin test might be a valuable GH provocative test, especially in the early phase of SAH.

Fatigue is a common symptom amongst SAH survivors. WFNS is a usable clinical determinant of fatigue in SAH survivors. Neither PD nor GHD has a significant effect on long-term fatigue after SAH.