Neuroendocrine dysfunction in patients recovering from subarachnoid hemorrhage.
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.
Jovanovic
Vladimir
V
Institute of Neurosurgery, Belgrade, Serbia.
Pekic
Sandra
S
Stojanovic
Marko
M
Tasic
Goran
G
Djurovic
Branko
B
Soldatovic
Ivan
I
Doknic
Mirjana
M
Miljic
Dragana
D
Djurovic
Marina
M
Medic-Stojanoska
Milica
M
Popovic
Vera
V
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
D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D012739:Gonadal Steroid Hormones; D010907:Pituitary Hormones; D013963:Thyroid Hormones