SAH Pituitary Adrenal Dysfunction

Vespa, Paul

doi:10.1007/s12028-011-9595-7

Cited by 5 publications

(1 citation statement)

References 22 publications

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“…Poll et al has found that patients with normal diurnal serum free cortisol measurement had a significantly shorter intensive care unit-stay, less complications and more favorable outcome [18] (Table 2). However, the empirical glucocorticoid replacement which is not based on the presence of documented acute HPA axis dysfunction may be harmful or, at best, ineffective [43].…”

Section: Impact Of Neuroendocrine Changes On Outcome Of the Patientmentioning

confidence: 99%

Neuroendocrine changes after aneurysmal subarachnoid haemorrhage

2019

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Introduction The prevalence of pituitary dysfunction is high following aneurysmal subarachnoid hemorrhage (aSAH) and when occurs it may contribute to residual symptoms of aSAH such as decreased cognition and quality of life. Hypopituitarism following aSAH may have non-specific, subtle symptoms and potentially serious consequences if remained undiagnosed. Methods We reviewed the literature on epidemiology, pathophysiology, diagnostic methods and management of neuroendocrine changes after aSAH as well as on the impact of pituitary dysfunction on outcome of the patient. Results The prevalence rates of pituitary dysfunction after aSAH varies greatly across studies due to different diagnostic methods, though growth hormone deficiency is generally the most frequently reported followed by adrenocorticotropic hormone, gonadotropin and thyroid stimulating hormone deficiencies. Pituitary deficiency tends to improve over time after aSAH but new onset deficiencies in chronic phase may also occur. There are no clinical parameters to predict the presence of hypopituitarism after aSAH. Age of the patient and surgical procedures are risk factors associated with development of hypopituitarism but the effect of pituitary dysfunction on outcome of the patient is not clear. Replacement of hypocortisolemia and hypothyroidism is essential but treatment of other hormonal insufficiencies should be individualized. Conclusions Hypopituitarism following aSAH necessitates screening despite lack of gold standard evaluation tests and cutoff values in the follow up, because missed diagnosis may lead to untoward consequences.

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Section: Impact Of Neuroendocrine Changes On Outcome Of the Patientmentioning

confidence: 99%