Pituitary dysfunction after aneurysmal subarachnoid haemorrhage: course and clinical predictors—the HIPS study.
OBJECTIVE
We describe the occurrence and course of anterior pituitary dysfunction (PD) after aneurysmal subarachnoid haemorrhage (SAH), and identify clinical determinants for PD in patients with recent SAH.


METHODS
We prospectively collected demographic and clinical parameters of consecutive survivors of SAH and measured fasting state endocrine function at baseline, 6 and 14 months. We included dynamic tests for growth-hormone function. We used logistic regression analysis to compare demographic and clinical characteristics of patients with SAH with and without PD.


RESULTS
84 patients with a mean age of 55.8 (±11.9) were included. Thirty-three patients (39%) had PD in one or more axes at baseline, 22 (26%) after 6 months and 6 (7%) after 14 months. Gonadotropin deficiency in 29 (34%) patients and growth hormone deficiency (GHD) in 26 (31%) patients were the most common deficiencies. PD persisted until 14 months in 6 (8%) patients: GHD in 5 (6%) patients and gonadotropin deficiency in 4 (5%). Occurrence of a SAH-related complication was associated with PD at baseline (OR 2.6, CI 2.2 to 3.0). Hydrocephalus was an independent predictor of PD 6 months after SAH (OR 3.3 CI 2.7 to 3.8). PD was associated with a lower score on health-related quality of life at baseline (p=0.06), but not at 6 and 14 months.


CONCLUSIONS
Almost 40% of SAH survivors have PD. In a small but substantial proportion of patients GHD or gonadotropin deficiency persists over time. Hydrocephalus is independently associated with PD 6 months after SAH.


BACKGROUND
NTR 2085.
Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
L
L
Khajeh
Department of Medicine, Section Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
K
K
Blijdorp
Department of Rehabilitation, Erasmus MC University Medical Center and Rijndam Rehabilitation Center Rotterdam, Rotterdam, The Netherlands.
M H
MH
Heijenbrok-Kal
Department of Rehabilitation, Erasmus MC University Medical Center and Rijndam Rehabilitation Center Rotterdam, Rotterdam, The Netherlands.
E M
EM
Sneekes
Department of Rehabilitation, Erasmus MC University Medical Center and Rijndam Rehabilitation Center Rotterdam, Rotterdam, The Netherlands.
H J G
HJ
van den Berg-Emons
Department of Medicine, Section Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
A J
AJ
van der Lely
Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
D W J
DW
Dippel
Department of Medicine, Section Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
S J C M M
SJ
Neggers
Department of Rehabilitation, Erasmus MC University Medical Center and Rijndam Rehabilitation Center Rotterdam, Rotterdam, The Netherlands.
G M
GM
Ribbers
Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
F
F
van Kooten
D005260:Female; D006062:Gonadotropins / Q000172:deficiency; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010900:Pituitary Diseases / Q000209:etiology* / Q000503:physiopathology; D010903:Pituitary Gland, Anterior / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications*
D006062:Gonadotropins
CLINICAL NEUROLOGY; ENDOCRINOLOGY; REHABILITATION; SUBARACHNOID HAEMORRHAGE