title: Pituitary deficiency after aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  Aneurysmal subarachnoid hemorrhage puts patients at high risk for the development of pituitary insufficiency. We evaluated the incidence of pituitary dysfunction in these patients and its correlation with clinical outcome.
  
  
  METHODS
  Pituitary function was tested in 66 consecutive patients in the first 15 days after aneurysmal subarachnoid hemorrhage. The following were measured in all patients: thyroid-stimulating hormone, free thyroxine, triiodothyronine, luteinizing hormone, follicle-stimulating hormone, total testosterone (in males), estradiol (in females), prolactin, serum cortisol, plasma adrenocorticotropic hormone, growth hormone and insulin growth factor.
  
  
  RESULTS
  The endocrine assessment was made at a mean of 7.4 days (standard deviation ±6.6) after subarachnoid hemorrhage. Forty-four (66.7%) female and 22 (33.3%) male patients were evaluated. Thirty-nine patients (59.1%) had some type of pituitary dysfunction. Follicle-stimulating hormone/luteinizing hormone deficiency was the most frequent disorder (34.8%), followed by growth hormone/insulin growth factor (28.7%), adrenocorticotropic hormone (18.1%) and thyroid-stimulating hormone (9%). Seventeen (25.7%) patients showed deficiencies in more than one axis. A greater incidence of hormone deficiency was observed in patients with a Glasgow Coma Scale score ≤13 (t test, p=0.008), Hunt-Hess grade ≥4 (t test, p<0.001), or Fisher grade 4 (t test, p=0.039). Hormone deficiency was not significantly associated (p>0.05) with increased hospitalization or clinical outcome.
  
  
  CONCLUSIONS
  Pituitary dysfunction was identified in a substantial portion of patients with previous aneurysmal subarachnoid hemorrhage, but no association was found between this dysfunction and poor clinical outcome.
authors.affiliation: Santa Casa de Belo Horizonte, Department of Neurosurgery, Belo Horizonte/MG, Brazil.
authors.forename: Julio Leonardo Barbosa
authors.initials: JL
authors.lastname: Pereira
authors.forename: Lucas Alverne Freitas de
authors.initials: LA
authors.lastname: Albuquerque
authors.forename: Marcos
authors.initials: M
authors.lastname: Dellaretti
authors.forename: Gervásio Teles Cardoso de
authors.initials: GT
authors.lastname: Carvalho
authors.forename: Gerival
authors.initials: G
authors.lastname: Vieira
authors.forename: Vitor Michelstaedter
authors.initials: VM
authors.lastname: Brochado
authors.forename: Austen Venâncio
authors.initials: AV
authors.lastname: Drummond
authors.forename: Joyce Espeschit de
authors.initials: JE
authors.lastname: Morais
authors.forename: Leticia Maia
authors.initials: LM
authors.lastname: Ferreira
authors.forename: Paulo Augusto Carvalho
authors.initials: PA
authors.lastname: Miranda
authors.forename: Atos Alves de
authors.initials: AA
authors.lastname: Sousa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010901:Pituitary Function Tests; D010902:Pituitary Gland / Q000503:physiopathology; D010907:Pituitary Hormones / Q000097:blood; D012016:Reference Values; D018709:Statistics, Nonparametric; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013963:Thyroid Hormones / Q000097:blood; D013997:Time Factors
chemical_list: D010907:Pituitary Hormones; D013963:Thyroid Hormones