title: Hypopituitarism is uncommon after aneurysmal subarachnoid haemorrhage.
abstract: OBJECTIVE
  Aneurysmal subarachnoid haemorrhage (SAH) has recently been reported as a common cause of chronic hypopituitarism, and introduction of routine neuroendocrine screening has been advocated. We aimed at estimating the risk of hypopituitarism after SAH using strict criteria including confirmatory testing in case of suggested insufficiency.
  
  
  METHODS
  Cross-sectional evaluation with a nested prospective subgroup. Patients and measurements Endocrine evaluation was performed at a median of 14 months (range 11-26) post-SAH in 62 patients with SAH and 30 healthy controls. Twenty-six patients were followed prospectively (median 7 days, and 12 months post-SAH). Endocrine evaluation included baseline evaluation, which was combined with an insulin tolerance test (ITT) or, if contraindicated, GHRH + arginine tests and a standard ACTH test at evaluation 1-2 years post-SAH. Pituitary insufficiencies were confirmed by re-evaluation.
  
  
  RESULTS
  Early post-SAH hormone alterations mimicking central hypogonadism were present in 58% of the patients and associated with a worse clinical state (P < 0.05). One to 2 years post-SAH, initial neuroendocrine evaluation identified seven patients (11%) with abnormal results; three had free T4 and TSH suggestive of central hypothyroidism, three men had testosterone below 10 nm, and one had an insufficient GH and cortisol response to the ITT. None of these abnormalities was confirmed upon confirmatory testing.
  
  
  CONCLUSIONS
  In the largest reported cohort of patients with SAH to date, with early and late endocrine evaluation, none of the patients had chronic hypopituitarism. Based on these findings, the introduction of routine neuroendocrine screening is not justified, and the data suggest the importance of using strict diagnostic criteria in patients with a low pretest probability of hypopituitarism.
authors.affiliation: Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark. klose@rh.dk
authors.forename: Marianne
authors.initials: M
authors.lastname: Klose
authors.forename: Jannick
authors.initials: J
authors.lastname: Brennum
authors.forename: Lars
authors.initials: L
authors.lastname: Poulsgaard
authors.forename: Michael
authors.initials: M
authors.lastname: Kosteljanetz
authors.forename: Aase
authors.initials: A
authors.lastname: Wagner
authors.forename: Ulla
authors.initials: U
authors.lastname: Feldt-Rasmussen
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007006:Hypogonadism / Q000209:etiology; D007018:Hypopituitarism / Q000209:etiology*; D007037:Hypothyroidism / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013739:Testosterone / Q000097:blood; D013972:Thyrotropin / Q000097:blood
chemical_list: D013739:Testosterone; D013972:Thyrotropin; D006854:Hydrocortisone