Hypocortisolism in Noncomatose Patients during the Acute Phase of Subarachnoid Hemorrhage

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

“…We also separately noted the percentage of endocrine abnormalities detected during the acute and chronic phase after SAH. The ''acute phase'' was defined as the occurrence of pituitary dysfunction within the first 6 months after aSAH, and the ''chronic phase'' included endocrine dysfunction occurring after 6 months from aSAH, as suggested by the authors [10][11][12][13][14][15][16][17][18].…”

“…The majority of them were prospective single-centre studies (N = 15, 75 %), two were prospective multi-centric Criteria for diagnosis of endocrine abnormality differed widely, and included both basal hormone levels and stimulation tests ( Table 2). Five authors studied just a single hormonal axis (somatotropic [10], or adrenal axis [13,[26][27][28]) and the remaining studied multiple hormone alterations.…”

“…Similar results were described by Pereira et al [15] who demonstrated that hormone deficiency is not significantly associated (p = 0.05) with increased hospitalization or clinical outcome. In opposition, some authors found a significant association between pituitary dysfunction and patients' outcome [11,13]: Lammert et al [24] demonstrated that all patients with neuro-endocrine dysfunction presented impaired clinical outcome (p value = 0.007) and Poll et al [28] found that patients with normal diurnal free serum cortisol had a significantly shorter ICUstay, less complications, and a more favorable outcome (p value = 0.051).…”

“…However, the studies addressing this issue are few and based on small patient cohorts [9-11, 13, 14]. Some are focused on the acute phase of aSAH [13,15], others on the chronic phase of aSAH [16,17], while some adress both [10,18]. There is substantial heterogeniety in the conclusions of these studies: although some suggest that hypopituitarism after aSAH affects only exceptional cases [19,20], others describe a high incidence reaching up to 50 % of cases [9,11,14].…”

Acute Glucocorticoid Deficiency and Diabetes Insipidus Are Common After Acute Traumatic Brain Injury and Predict Mortality

“…In the last 10 years, there has been an increasing interest in acute hypopituitarism, occurring immediately after TBI, but the evidence base for its existence has not been systematically assessed. The pituitary axis of most concern immediately after TBI is the hypothalamo-pituitary-adrenal axis because the consequences of glucocorticoid deficiency after TBI are potentially fatal, resulting in life-threatening hyponatremia (11) and hypotension requiring pressor support (12); acute hypocortisolemia has recently been linked to mortality after subarachnoid hemorrhage (13). To date, there have been only 7 major studies of pituitary dysfunction in the first 2 weeks after TBI; these have reported an incidence of ACTH deficiency of between 4% and 53% (10, 12, 14 -18).…”