title: Neuroendocrine dysfunction in patients recovering from subarachnoid hemorrhage.
abstract: OBJECTIVE
  Subarachnoid hemorrhage (SAH) is a recently identified risk factor for hypopituitarism, particularly growth hormone (GH) and corticotrophins deficiencies. The aim of our study was to identify possible predictor(s) for neuroendocrine dysfunction in SAH survivors.
  
  
  METHODS
  Pituitary function was evaluated in 93 patients (30 males, 63 females), aged 48.0+/-1.1 years (mean+/-SE), and with a Glasgow Outcome Scale score of 4.6+/-0.6 (mean+/-SE) more than one year following SAH. In the acute phase, SAH was complicated by vasospasm (VS) in 18 and by hydrocephalus (HDC) in 9 patients. Baseline serum values of insulin growth factor 1 (IGF-I), cortisol, thyroxine (T4), thyroid stimulating hormone (TSH), follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (in males), estradiol (in females) and prolactin were determined.
  
  
  RESULTS
  According to the results of baseline hormonal evaluation, 47 patients (50.5%) had no hormonal abnormalities. Seven patients (7.5%) had multiple pituitary hormone deficiencies: Four patients (4.3%) had two (GH and cortisol), one patient had three (gonadal, adrenal and GH) and two patients had deficiency of all pituitary axes. Thirty-nine patients (42%) had one abnormal axis (13 adrenal, 2 thyroid, 4 gonadal and 20 GH). None of the subjects was treated with desmopressin or exhibited symptomatic polyuria. The VS and HDC during the acute phase of SAH were related to abnormal pituitary status (VS with low IGF-I levels and HDC with low cortisol levels).
  
  
  CONCLUSIONS
  Through a screening procedure, neuroendocrine dysfunction was identified in a substantial number of asymptomatic patients with previous SAH. Cerebral VS and HDC at the time of SAH emerged as risk factors possibly predicting development of pituitary dysfunction. Low basal levels of IGF 1 and cortisol may help in selecting patients requiring further evaluation of pituitary function.
authors.affiliation: Institute of Neurosurgery, Belgrade, Serbia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Jovanovic
authors.forename: Sandra
authors.initials: S
authors.lastname: Pekic
authors.forename: Marko
authors.initials: M
authors.lastname: Stojanovic
authors.forename: Goran
authors.initials: G
authors.lastname: Tasic
authors.forename: Branko
authors.initials: B
authors.lastname: Djurovic
authors.forename: Ivan
authors.initials: I
authors.lastname: Soldatovic
authors.forename: Mirjana
authors.initials: M
authors.lastname: Doknic
authors.forename: Dragana
authors.initials: D
authors.lastname: Miljic
authors.forename: Marina
authors.initials: M
authors.lastname: Djurovic
authors.forename: Milica
authors.initials: M
authors.lastname: Medic-Stojanoska
authors.forename: Vera
authors.initials: V
authors.lastname: Popovic
mesh_terms: D000305:Adrenal Cortex Hormones / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003480:Cushing Syndrome / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D023261:Glasgow Outcome Scale; D012739:Gonadal Steroid Hormones / Q000097:blood; D006066:Gonads / Q000378:metabolism; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D007018:Hypopituitarism / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010901:Pituitary Function Tests; D010907:Pituitary Hormones / Q000097:blood*; D010913:Pituitary-Adrenal System / Q000378:metabolism* / Q000503:physiopathology; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D013961:Thyroid Gland / Q000378:metabolism; D013963:Thyroid Hormones / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000209:etiology
chemical_list: D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D012739:Gonadal Steroid Hormones; D010907:Pituitary Hormones; D013963:Thyroid Hormones