Diagnosing neuroendocrine dysfunction in patients after aneurysmal subarachnoid hemorrhage in clinical practice - does basal hormone screening make sense?
Recent studies indicate that neuroendocrine dysfunction is a more frequent sequel of aneurysmal subarachnoid hemorrhage (SAH), than has so far been recognized. However, from the available data it remains unclear whether certain subgroups of SAH patients carry a higher risk to sustain endocrine sequelae due to the hemorrhage than others and should be specifically followed up in terms of hormone assessment. To investigate whether a basal hormone screening is a practical method in clinical routine to single out patients in whom endocrine function testing is warranted, we established a screening protocol, based on the findings from a cohort of 40 SAH patients (study group) who had all been investigated by basal hormone para meters as well as standardized endocrinological function testing, within the framework of a previously published clinical study. We then applied this protocol to 45 newly investigated SAH-patients (screening group). According to the thus established protocol, 20 of the 45 screened patients (44.4 %) were recommended further investigations, 12 of whom agreed to undergo dynamic endocrine function testing. Altogether, the percentage of test-confirmed neuroendocrine dysfunction was only 13.3 % (6/ 45) in the screening group as compared to 55 % in the study group. Low IGF-I (2 SD below normal) did not serve to predict growth hormone deficiency, whereas low 9 am serum cortisol was of limited value to single out ACTH-deficiency in SAH-patients. In summary we conclude that basal hormone screening is not sufficient to identify SAH patients with impaired hypothalamo-pituitary function, at least not in the context of clinical routine practice.
Kreitschmann-Andermahr
I
I
Department of Neurosurgery, University Hospital RWTH Aachen, Germany. ikreitschmann-andermahr@ukaachen.de
Poll
E M
EM
Reineke
A
A
Langejürgen
Y
Y
Yagmur
E
E
Gilsbach
J M
JM
Saller
B
B
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D003940:Diagnostic Techniques, Endocrine / Q000592:standards*; D004700:Endocrine System Diseases / Q000097:blood / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D004958:Estradiol / Q000097:blood; D005260:Female; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D009490:Neurosecretory Systems / Q000378:metabolism / Q000503:physiopathology*; D011388:Prolactin / Q000097:blood; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D013739:Testosterone / Q000097:blood; D013974:Thyroxine / Q000097:blood
D006728:Hormones; D013739:Testosterone; D004958:Estradiol; D011388:Prolactin; D013974:Thyroxine; D006854:Hydrocortisone