Quality of life and psychiatric sequelae following aneurysmal subarachnoid haemorrhage: does neuroendocrine dysfunction play a role?
OBJECTIVE
Patients who have sustained aneurysmal subarachnoid haemorrhage (SAH) often suffer persistent impairments in their quality of life (QoL) and psychological disturbances despite a good neurological outcome. In the light of the high prevalence of partial hypopituitarism in SAH survivors demonstrated in recent investigations, we aimed to determine whether neuroendocrine dysfunction has an impact on QoL and neurobehavioural symptoms in these patients.


METHODS
QoL, depression and psychological distress were assessed in 40 SAH survivors who had undergone endocrine function testing at least 1 year after the haemorrhage.


METHODS
QoL was assessed using the Nottingham Health Profile (NHP), the Quality of Life Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA) and the Short Form-36 questionnaire (SF-36). The Beck Depression Inventory (BDI) and the Impact of Event Scale (IES) were used to evaluate depression and symptoms of current subjective distress in response to the SAH as a stressful life event, respectively.


RESULTS
In a stepwise multiple regression analysis, basal cortisol level was included as the first and often only predictor for several QoL domains assessing psychological aspects of well-being and depression whereas physical aspects of QoL were predicted primarily by neurological recovery from the SAH. Severe GH deficiency (GHD) was the first predictor for the criterion NHP subscale 'Energy' and highest stimulated ACTH level in the insulin tolerance test (ITT) was the first predictor for disturbed sleep as assessed with the NHP subscale 'Sleep'.


CONCLUSIONS
Our results provide preliminary data that neuroendocrine disturbances contribute to disturbed QoL, depression and sleeping disturbances in SAH patients.
Kreitschmann-Andermahr
Ilonka
I
Department of Neurosurgery, University of Technology Aachen, Aachen, Germany. ikreitschmann-andermahr@ukaachen.de
Poll
Eva
E
Hutter
Bernd O
BO
Reineke
Andrea
A
Kristes
Sabine
S
Gilsbach
Joachim M
JM
Saller
Bernhard
B
D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D017542:Aneurysm, Ruptured / Q000097:blood / Q000523:psychology*; D019540:Area Under Curve; D003866:Depressive Disorder / Q000097:blood / Q000209:etiology* / Q000523:psychology; D005260:Female; D013006:Growth Hormone / Q000097:blood; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D002532:Intracranial Aneurysm / Q000097:blood / Q000523:psychology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011788:Quality of Life; D013345:Subarachnoid Hemorrhage / Q000097:blood / Q000523:psychology*
D006728:Hormones; D000324:Adrenocorticotropic Hormone; D013006:Growth Hormone; D006854:Hydrocortisone