Pituitary Dysfunction After Aneurysmal Subarachnoid Hemorrhage Is Associated with Impaired Early Outcome

Kronvall, Erik; Valdemarsson, Stig; Säveland, Hans; Nilsson, Ola

doi:10.1016/j.wneu.2013.10.038

Cited by 21 publications

(26 citation statements)

References 32 publications

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“…Santarsieri et al (38) recently measured cortisol in the cerebrospinal fluid of the TBI patients and showed persistently elevated cortisol during the first 6 days after trauma, which was associated with poorer outcomes, as measured by Glasgow Outcome Scale scores and Functional Independence Measure cognitive scores 6 months after the injury. Recently, pituitary abnormalities in 27% of patients 3-6 months after a subarachnoid haemorrhage were significantly related to lower median Glasgow Outcome Scale scores at follow-up, with more prevalent endocrine abnormalities occurring when bleeding sites were closer to the hypothalamus (39). In contrast to the present and previously mentioned studies, other authors did not find an association between endocrine alterations and Glasgow Outcome Scale-Extended score measures (37,40) or other quality-of-life questionnaires (18,20).…”

Section: European Journal Of Endocrinologycontrasting

confidence: 95%

Early endocrine alterations reflect prolonged stress and relate to 1-year functional outcome in patients with severe brain injury

Marina

Klose

Nordenbo

et al. 2015

European Journal of Endocrinology

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Objective: Severe brain injury may increase the risk of developing acute and chronic hypopituitarism. Pituitary hormone alterations developed in the early recovery phase after brain injury may have implications for long-term functional recovery. The objective of the present study was to assess the pattern and prevalence of pituitary hormone alterations 3 months after a severe brain injury with relation to functional outcome at a 1-year follow-up. Design: Prospective study at a tertiary university referral centre. Methods: A total of 163 patients admitted to neurorehabilitation after severe traumatic brain injury (TBI, nZ111) or non-TBI (nZ52) were included. The main outcome measures were endocrine alterations 3.3 months (median) after the brain injury and their relationship to the functioning and ability of the patients at a 1-year follow-up, as measured by the Functional Independence Measure and the Glasgow Outcome Scale-Extended. Results: Three months after the injury, elevated stress hormones (i.e. 30 min stimulated cortisol, prolactin and/or IGF1) and/or suppressed gonadal or thyroid hormones were recorded in 68 and 32% of the patients respectively. At 1 year after the injury, lower functioning level (Functional Independence Measure) and lower capability of performing normal life activities (Glasgow Outcome Scale-Extended) were related to both the elevated stress hormones (P%0.01) and the reduced gonadal and/or thyroid hormones (P%0.01) measured at 3 months. Conclusion: The present study suggests that brain injury-related endocrine alterations that mimic secondary hypogonadism and hypothyroidism and that occur with elevated stress hormones most probably reflect a prolonged stress response 2-5 months after severe brain injury, rather than pituitary insufficiency per se. These endocrine alterations thus seem to reflect a more severe disease state and relate to 1-year functional outcome.

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Section: European Journal Of Endocrinologycontrasting

confidence: 95%

Early endocrine alterations reflect prolonged stress and relate to 1-year functional outcome in patients with severe brain injury

Marina

Klose

Nordenbo

et al. 2015

European Journal of Endocrinology

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“…Using the GOS scale, we could not detect any relation between outcome and the presence of neuroendocrine dysfunction, although our earlier endocrine evaluations of the present study population suggested an inverse relationship between pituitary dysfunction and GOS (17). This is probably explained by the generally benign clinical course where most of included patients had a good recovery (GOS score of 5) at long-term follow-up.…”

Section: Consequences For the Recovery After Subarachnoid Hemorrhagecontrasting

confidence: 79%

“…Thus, an underestimation of the true prevalence of central hypogonadism cannot be excluded. Other longitudinal studies, as well as early data from the present study cohort, suggest that gonadotropic dysfunction is frequent early after SAH but later restitutes in many patients (13,15,17,26).…”

Section: Thyrotropic Deficiency and Hypogonadismsupporting

confidence: 61%

“…Patients from whom informed consent could not be obtained and patients who declined to participate were excluded. Baseline characteristics and data on acute management have been described in detail earlier (17) and are summarized in Table 1. For the endocrine evaluation, blood and urine sampling was performed at 6e12 and 12e24 months after the bleed.…”

Section: Patient Selection and Endocrine Evaluationmentioning

confidence: 99%

“…Data on early outcome and endocrine profile have been presented previously (17). For a reliable assessment of the long-term effects on the hypothalamic-pituitaryadrenal (HPA) axis and growth hormone (GH) secretion, we used the insulin tolerance test (ITT), which is the gold standard for evaluation of hypothalamic-pituitary function.…”

Section: Introductionmentioning

confidence: 99%

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High Prevalence of Pituitary Dysfunction After Aneurysmal Subarachnoid Hemorrhage: A Long-Term Prospective Study Using Dynamic Endocrine Testing

Kronvall¹,

Valdemarsson²,

Säveland³

et al. 2015

World Neurosurgery

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The prevalence of growth hormone deficiency in survivors of subarachnoid haemorrhage: results from a large single centre study

et al. 2017

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ObjectiveThe variation in reported prevalence of growth hormone deficiency (GHD) post subarachnoid haemorrhage (SAH) is mainly due to methodological heterogeneity. We report on the prevalence of GHD in a large cohort of patients following SAH, when dynamic and confirmatory pituitary hormone testing methods are systematically employed.DesignIn this cross-sectional study, pituitary function was assessed in 100 patients following SAH. Baseline pituitary hormonal profile measurement and glucagon stimulation testing (GST) was carried out in all patients. Isolated GHD was confirmed with an Arginine stimulation test and ACTH deficiency was confirmed with a short synacthen test.ResultsThe prevalence of hypopituitarism in our cohort was 19% and the prevalence of GHD was 14%. There was no association between GHD and the clinical or radiological severity of SAH at presentation, treatment modality, age, or occurrence of vasospasm. There were statistically significant differences in terms of Glasgow Outcome Scale (GOS; p = 0.03) between patients diagnosed with GHD and those without. Significant inverse correlations between GH peak on GST with body mass index (BMI) and waist hip ratio (WHR) was also noted (p < 0.0001 and p < 0.0001 respectively).ConclusionUsing the current testing protocol, the prevalence of GHD detected in our cohort was 14%. It is unclear if the BMI and WHR difference observed is truly due to GHD or confounded by the endocrine tests used in this protocol. There is possibly an association between the development of GHD and worse GOS score. Routine endocrine screening of all SAH survivors with dynamic tests is time consuming and may subject many patients to unnecessary side-effects. Furthermore the degree of clinical benefit derived from growth hormone replacement in this patient group, remains unclear. Increased understanding of the most appropriate testing methodology in this patient group and more importantly which SAH survivors would derive most benefit from GHD screening is required.

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Pituitary Dysfunction After Aneurysmal Subarachnoid Hemorrhage Is Associated with Impaired Early Outcome

Cited by 21 publications

References 32 publications

Early endocrine alterations reflect prolonged stress and relate to 1-year functional outcome in patients with severe brain injury

Early endocrine alterations reflect prolonged stress and relate to 1-year functional outcome in patients with severe brain injury

High Prevalence of Pituitary Dysfunction After Aneurysmal Subarachnoid Hemorrhage: A Long-Term Prospective Study Using Dynamic Endocrine Testing

The prevalence of growth hormone deficiency in survivors of subarachnoid haemorrhage: results from a large single centre study

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