Clinical prevalence and outcome impact of pituitary dysfunction after aneurysmal subarachnoid hemorrhage: a systematic review with meta-analysis.
OBJECTIVE
Pituitary dysfunction is reported to be a common complication following aneurysmal subarachnoid hemorrhage (aSAH). The aim of this meta-analysis is to analyze the literature on clinical prevalence, risk factors and outcome impact of pituitary dysfunction after aSAH, and to assess the possible need for pituitary screening in aSAH patients.


METHODS
We performed a systematic review with meta-analysis based on a comprehensive search of four databases (PubMed/MEDLINE, ISI/Web of Science, Scopus and Google Scholar).


RESULTS
A total of 20 papers met criteria for inclusion. The prevalence of pituitary dysfunction in the acute phase (within the first 6 months after aSAH) was 49.30 % (95 % CI 41.6-56.9), decreasing in the chronic phase (after 6 months from aSAH) to 25.6 % (95 % CI 18.0-35.1). Abnormalities in basal hormonal levels were more frequent when compared to induction tests, and the prevalence of a single pituitary hormone dysregulation was more frequent than multiple pituitary hormone dysregulation. Increasing age was associated with a lower prevalence of endocrine dysfunction in the acute phase, and surgical treatment of the aneurysm (clipping) was related to a higher prevalence of single hormone dysfunction. The prevalence of pituitary dysfunction did not correlate with the outcome of the patient.


CONCLUSIONS
Neuroendocrine dysfunction is common after aSAH, but these abnormalities have not been shown to consistently impact outcome in the data available. There is a need for well-designed prospective studies to more precisely assess the incidence, clinical course, and outcome impact of pituitary dysfunction after aSAH.
Neurosciences Critical Care Unit, Addenbrooke's Hospital, Cambridge University, Cambridge University Hospitals Trust, Box 1, Hills Road, Cambridge, CB2 0QQ, UK. kiarobba@gmail.com.
Chiara
C
Robba
Department of Neurosurgery, Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy.
Susanna
S
Bacigaluppi
Department of Health Sciences (DISSAL), University of Genoa, Largo Rosanna Benzi, 15, 16100, Genoa, Italy.
Nicola
N
Bragazzi
Neurosciences Critical Care Unit, Addenbrooke's Hospital, Cambridge University, Cambridge University Hospitals Trust, Box 1, Hills Road, Cambridge, CB2 0QQ, UK.
Andrea
A
Lavinio
Department of Medicine, Addenbrooke's Hospital, Cambridge University, Cambridge University Hospitals Trust, Box 1, Hills Road, Cambridge, CB2 0QQ, UK.
Mark
M
Gurnell
Department of Anesthesiology, University of Rome "La Sapienza", Piazzale Aldo Moro 5, 00185, Rome, Italy.
Federico
F
Bilotta
Neurosciences Critical Care Unit, Addenbrooke's Hospital, Cambridge University, Cambridge University Hospitals Trust, Box 1, Hills Road, Cambridge, CB2 0QQ, UK.
David K
DK
Menon
D002908:Chronic Disease; D006801:Humans; D010900:Pituitary Diseases / Q000453:epidemiology* / Q000209:etiology*; D010902:Pituitary Gland / Q000503:physiopathology; D015995:Prevalence; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000503:physiopathology
Aneurysmal subarachnoid hemorrhage; Outcome; Pituitary dysfunction; Screening; Systematic review with meta-analysis