Pituitary dysfunction after aneurysmal subarachnoid haemorrhage: course and clinical predictors—the HIPS study

Abstract

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.

The six-minute walk test predicts cardiorespiratory fitness in individuals with aneurysmal subarachnoid hemorrhage

“…25 The present study describes measures of physical fitness that were obtained six months after a-SAH. The study was approved by the Medical Ethics Committee of the Erasmus University Medical Center, and all participants gave written informed consent.…”

Pituitary Dysfunction After Aneurysmal Subarachnoid Hemorrhage

“…After a multivariate analysis controlling for age, gender, and hypertension, occurrence of an aSAH-related complication (hydrocephalus, rebleeding, vasospasm, intraparenchymal hematoma, hypertension, or hyponatremia) was associated with new post-aSAH baseline pituitary dysfunction; hydrocephalus was an independent predictor of pituitary dysfunction 6 months after aSAH (5). Aneurysm location, World Federation of Neurosurgical Societies grade, and treatment modality (clipping or coiling) were not significantly associated with the occurrence of pituitary dysfunction.…”

“…In the recently published Hypopituitarism In Patients with Subarachnoid hemorrhage (HIPS) study, a prospective evaluation of 84 patients surviving aSAH, 39% of patients had pituitary dysfunction at their new post-aSAH baseline, 26% had pituitary dysfunction after 6 months, and 7% had pituitary dysfunction after 14 months (5). Pituitary dysfunction at follow-up did not occur in patients with normal pituitary function at their post-aSAH baseline.…”

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P ituitary dysfunction affecting at least 1 axis after aneurysmal subarachnoid hemorrhage (aSAH) is common, reported at rates of 37%e55% in contemporary studies (1,3,(5)(6)(7). Despite the frequency of this clinically relevant complication of aSAH, it has been studied in only a few, relatively small studies.

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“…Although precise rates of pituitary dysfunction after aSAH vary considerably across studies (1, 3, 5-9), they most consistently demonstrate a relative preponderance of growth hormone (GH) deficiency and, less frequently, disturbances of the thyrotropin axis (1,3,5,6,8,9). Patients with GH deficiency may exhibit fatigue or low energy as well as impaired cognition, adversely affecting quality of life (2, 8).…”