High Incidence of Neuroendocrine Dysfunction in Long-Term Survivors of Aneurysmal Subarachnoid Hemorrhage

Abstract

Background and Purpose-To investigate the incidence, pattern, and magnitude of neuroendocrine changes in long-term survivors of aneurysmal subarachnoid hemorrhage (SAH). Methods-Thirty patients (16 women) with a mean age of 50Ϯ13 years underwent endocrine assessment between 12 and 24 months after aneurysmal SAH. SAH severity was graded clinically by the Hunt & Hess scale (median, II) and radiologically by the Fisher classification (median, II). Patients underwent measurement of basal hormone levels and dynamic assessment by the low-dose (1 g) corticotropin stimulation test. Functional outcome was examined concurrently with endocrine testing by the modified Rankin Scale and the Barthel Index. Results-Of the 30 patients tested, 14 patients (47%) showed isolated or combined endocrine abnormalities. These included low insulin-like growth factor 1 levels compatible with growth hormone deficiency in 37%, hypogonadism in 13%, and cortisol hyporesponsiveness to the low-dose corticotropin stimulation test in 10%; thyroid dysfunction in the form of subclinical hypothyroidism was observed in 7% of patients. Median modified Rankin Scale and Barthel Index at the time of endocrine testing were 1 and 100, respectively. There was no correlation between the presence of endocrine dysfunction and SAH severity indices or functional outcome scores. Conclusions-Long-term survivors of aneurysmal SAH frequently exhibit endocrine changes, with growth hormone and gonadal deficiencies predominating. Thus, screening of pituitary function is recommended in patients surviving SAH. The relationship between late hormonal alterations and functional outcome in patients with SAH warrants further study.

Neuroendocrine dysfunction in patients recovering from subarachnoid hemorrhage

“…[1][2][3][4][5][6][7][8]12 The first large multicenter study on SAH patients was carried out by Aimaretti and colleagues who investigated 40 patients three months after SAH and diagnosed a variable degree of hypopituitarism in 37.5% of the patients. 5 In contrast to TBI, pituitary deficits after SAH are more often isolated than multiple and panhypopituitarism has not been reported.…”

“…[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).…”

“…Recent reports indicate a high prevalence of pituitary and hypothalamic abnormalities following SAH and TBI. [1][2][3][4][5][6]8 It is still unclear whether the observed cognitive deficits are a consequence of the brain injury itself or are also related, at least in part, to the resulting anterior pituitary hormone deficiencies.…”

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

“…Both treatment groups exhibited cognitive impairments in memory, attention and speed of information processing (4). Previous clinical studies have indicated that long-term survivors of aSAH frequently exhibit hypothyroidism (5,6). Furthermore, cognitive dysfunctions in these patients resemble the disruptions observed in patients with hypothyroidism.…”

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

“…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.…”