title: Pituitary dysfunction after aneurysmal subarachnoid hemorrhage is associated with impaired early outcome.
abstract: OBJECTIVE
  Poor outcome and neuropsychological sequelae after aneurysmal subarachnoid hemorrhage (SAH) is a persistent problem. Pituitary dysfunction has been proposed as a contributing factor. Clinical studies have given variable and conflicting results on its importance and incidence after SAH. The aim of this study was to prospectively examine SAH patients with assessment of endocrine function in the acute stage and at early follow-up and to compare clinical SAH features to endocrine abnormalities indicating pituitary dysfunction.
  
  
  METHODS
  Endocrine function was assessed by basal hormonal concentrations at 5 to 10 days and 3 to 6 months after SAH. Growth hormone deficiency also was evaluated by the growth hormone releasing hormone-arginine stimulation test at follow-up. Clinical outcome was assessed and scored according to the Glasgow Outcome Scale.
  
  
  RESULTS
  Fifty-one SAH patients were included and assessed in the acute stage after the bleed. Six were lost to follow-up. The overall prevalence of pituitary dysfunction was 37% and 27% in the acute stage and at follow-up, respectively. Patients with evidence of pituitary dysfunction had significantly worse outcome according to Glasgow Outcome Scale at both occasions. The ruptured aneurysm was more commonly located in the circle of Willis among patients with pituitary dysfunction in the acute stage.
  
  
  CONCLUSIONS
  The present results support earlier findings that hormonal abnormalities are not infrequent after SAH. Furthermore, our data suggest that pituitary dysfunction is associated with worse clinical outcome and is more common among patients with bleeding sites close to the hypothalamus.
authors.affiliation: Department of Neurosurgery, Lund University, Skåne University Hospital, Lund, Sweden. Electronic address: erik.kronvall@med.lu.se.
authors.forename: Erik
authors.initials: E
authors.lastname: Kronvall
authors.affiliation: Department of Oncology, Lund University, Skåne University Hospital, Lund, Sweden.
authors.forename: Stig
authors.initials: S
authors.lastname: Valdemarsson
authors.affiliation: Department of Neurosurgery, Lund University, Skåne University Hospital, Lund, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Säveland
authors.affiliation: Department of Neurosurgery, Lund University, Skåne University Hospital, Lund, Sweden.
authors.forename: Ola G
authors.initials: OG
authors.lastname: Nilsson
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006728:Hormones / Q000097:blood; D006801:Humans; D007018:Hypopituitarism / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006728:Hormones
keywords: Growth hormone deficiency; Hypopituitarism; Outcome; Pituitary deficiency; Subarachnoid hemorrhage