title: Hypopituitarism after subarachnoid haemorrhage, do we know enough?
abstract: BACKGROUND
  Fatigue, slowness, apathy and decrease in level of activity are common long-term complaints after a subarachnoid haemorrhage (SAH). They resemble the symptoms frequently found in patients with endocrine dysfunction. Pituitary dysfunction may be the result of SAH or its complications. We therefore hypothesized that it may explain some of the long-term complaints after SAH. We reviewed the literature to clarify the occurrence, pattern and severity of endocrine abnormalities and we attempted to identify risk factors for hypopituitarism after SAH. We also assessed the effect of hypopituitarism on long-term functional recovery after SAH.
  
  
  METHODS
  In a MEDLINE search for studies published between 1995 and 2014, we used the term subarachnoid haemorrhage in combination with pituitary, hypopituitarism, growth hormone, gonadotropin, testosterone, cortisol function, thyroid function and diabetes insipidus. We selected all case-series and cohort studies reporting endocrine function at least 3 months after SAH and studied their reported prevalence, pathogenesis, risk factors, clinical course and outcome.
  
  
  RESULTS
  We identified 16 studies describing pituitary function in the long term after SAH. The reported prevalence of endocrine dysfunction varied from 0 to 55% and the affected pituitary axes differed between studies. Due to methodological issues no inferences on risk factors, course and outcome could be made.
  
  
  CONCLUSIONS
  Neuroendocrine dysfunction may be an important and modifiable determinant of poor functional outcome after SAH. There is an urgent need for well-designed prospective studies to more precisely assess its incidence, clinical course and effect on mood, behaviour and quality of life.
authors.affiliation: Department of Neurology, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands. l.khajeh@erasmusmc.nl.
authors.forename: Ladbon
authors.initials: L
authors.lastname: Khajeh
authors.affiliation: Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands. k.blijdorp@erasmusmc.nl.
authors.forename: Karin
authors.initials: K
authors.lastname: Blijdorp
authors.affiliation: Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands. s.neggers@erasmusmc.nl.
authors.forename: Sebastian Jcmm
authors.initials: SJ
authors.lastname: Neggers
authors.affiliation: Department of Rehabilitation Medicine, Erasmus MC University Medical Centre and Rijndam Rehabilitation Centre, Rotterdam, the Netherlands. g.ribbers@erasmusmc.nl.
authors.forename: Gerard M
authors.initials: GM
authors.lastname: Ribbers
authors.affiliation: Department of Neurology, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands. d.dippel@erasmusmc.nl.
authors.forename: Diederik Wj
authors.initials: DW
authors.lastname: Dippel
authors.affiliation: Department of Neurology, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands. f.vankooten@erasmusmc.nl.
authors.forename: Fop
authors.initials: F
authors.lastname: van Kooten
mesh_terms: D006801:Humans; D007018:Hypopituitarism / Q000209:etiology*; D015994:Incidence; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications*