title: High prevalence of pituitary dysfunction after aneurysmal subarachnoid hemorrhage: a long-term prospective study using dynamic endocrine testing.
abstract: OBJECTIVE
  Impaired systemic hormonal activity caused by hypothalamic and pituitary injury may contribute to neuropsychologic disturbances and poor quality of life after aneurysmal subarachnoid hemorrhage (SAH). This prospective study was designed to longitudinally evaluate long-term clinical outcome and pituitary function after SAH using dynamic tests for adrencorticotropic and somatotropic secretory capacity.
  
  
  METHODS
  Endocrine function was assessed by basal hormonal concentrations at 6-12 months and 12-24 months after SAH. At the 12-24 months follow-up, dynamic provocative evaluation of adrenocorticotropic hormone (ACTH) and growth hormone (GH) was performed using the insulin tolerance test (ITT). In patients where ITT was contraindicated, an ACTH stimulation test was used to assess ACTH capacity, and a growth hormone releasing hormone (GHRH)-arginine stimulation test was used to assess GH capacity.
  
  
  RESULTS
  Of 60 patients with SAH screened, 51 were included in the study, and 44 remained to be tested at the two follow-up visits. As assessed by basal hormone concentrations alone, the prevalence of pituitary dysfunction was 34% at 6-12 months and 41% at 12-24 months. When using dynamic tests (12-24 months), impaired pituitary function was detected in 43%. The ITT detected more cases of central hypoadrenalism and GH deficiency compared with the ACTH- and GHRH-arginine-stimulation tests, respectively.
  
  
  CONCLUSIONS
  Application of dynamic endocrine tests revealed a high frequency of long-term hypothalamic-pituitary dysfunction after aneurysmal SAH. The role of pituitary dysfunction in the recovery after SAH merits further evaluation.
authors.affiliation: Department of Clinical Sciences, Lund, Neurosurgery, Lund University, Lund, Sweden. Electronic address: erik.kronvall@med.lu.se.
authors.forename: Erik
authors.initials: E
authors.lastname: Kronvall
authors.affiliation: Department of Clinical Sciences, Lund, Oncology, Lund University, Lund, Sweden.
authors.forename: Stig
authors.initials: S
authors.lastname: Valdemarsson
authors.affiliation: Department of Clinical Sciences, Lund, Neurosurgery, Lund University, Lund, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Säveland
authors.affiliation: Department of Clinical Sciences, Lund, Neurosurgery, Lund University, Lund, Sweden.
authors.forename: Ola G
authors.initials: OG
authors.lastname: Nilsson
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D005260:Female; D005951:Glucose Tolerance Test; D013007:Growth Hormone-Releasing Hormone / Q000097:blood; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D010900:Pituitary Diseases / Q000453:epidemiology* / Q000209:etiology*; D010901:Pituitary Function Tests / Q000379:methods* / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000453:epidemiology*; D016896:Treatment Outcome
chemical_list: D019382:Human Growth Hormone; D000324:Adrenocorticotropic Hormone; D013007:Growth Hormone-Releasing Hormone
keywords: Growth hormone deficiency; Hypopituitarism; Outcome; Pituitary deficiency; Subarachnoid hemorrhage