title: Can cardiac surgery cause hypopituitarism?
abstract: Apoplexy of pituitary adenomas with subsequent hypopituitarism is a rare but well recognized complication following cardiac surgery. The nature of cardiac on-pump surgery provides a risk of damage to the pituitary because the vascular supply of the pituitary is not included in the cerebral autoregulation. Thus, pituitary tissue may exhibit an increased susceptibility to hypoperfusion, ischemia or intraoperative embolism. After on-pump procedures, patients often present with physical and psychosocial impairments which resemble symptoms of hypopituitarism. Therefore, we analyzed whether on-pump cardiac surgery may cause pituitary dysfunction also in the absence of pre-existing pituitary disease. Twenty-five patients were examined 3-12 months after on-pump cardiac surgery. Basal hormone levels for all four anterior pituitary hormone axes were measured and a short synacthen test and a growth hormone releasing hormone plus arginine (GHRH-ARG)-test were performed. Quality of life (QoL), depression, subjective distress for a specific life event, sleep quality and fatigue were assessed by means of self-rating questionnaires. Hormonal alterations were only slight and no signs of anterior hypopituitarism were found except for an insufficient growth hormone rise in two overweight patients in the GHRH-ARG-test. Psychosocial impairment was pronounced, including symptoms of moderate to severe depression in 9, reduced mental QoL in 8, dysfunctional coping in 6 and pronounced sleep disturbances in 16 patients. Hormone levels did not correlate with psychosocial impairment. On-pump cardiac surgery did not cause relevant hypopituitarism in our sample of patients and does not serve to explain the psychosocial symptoms of these patients.
authors.affiliation: Department of Neurosurgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: Flverly
authors.initials: F
authors.lastname: Francis
authors.forename: Ines
authors.initials: I
authors.lastname: Burger
authors.forename: Eva Maria
authors.initials: EM
authors.lastname: Poll
authors.forename: Andrea
authors.initials: A
authors.lastname: Reineke
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Strasburger
authors.forename: Guido
authors.initials: G
authors.lastname: Dohmen
authors.forename: Joachim M
authors.initials: JM
authors.lastname: Gilsbach
authors.forename: Ilonka
authors.initials: I
authors.lastname: Kreitschmann-Andermahr
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010900:Pituitary Diseases / Q000209:etiology; D010911:Pituitary Neoplasms / Q000209:etiology; D011183:Postoperative Complications; D011788:Quality of Life; D013903:Thoracic Surgery