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Pituitary dysfunction after aneurysmal subarachnoid hemorrhage is associated with impaired early outcome

Kronvall, Erik LU ; Valdemarsson, Stig LU ; Säveland, Hans LU and Nilsson, Ola G. LU (2014) In World Neurosurgery 81(3-4). p.529-537
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... (More)

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.

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organization
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type
Contribution to journal
publication status
published
subject
keywords
Growth hormone deficiency, Hypopituitarism, Outcome, Pituitary deficiency, Subarachnoid hemorrhage
in
World Neurosurgery
volume
81
issue
3-4
pages
9 pages
publisher
Elsevier
external identifiers
  • Scopus:84898042891
  • WOS:000335581200032
ISSN
1878-8750
DOI
10.1016/j.wneu.2013.10.038
language
English
LU publication?
yes
id
550668b4-75f7-4567-83f3-72a9d141e631 (old id 4143157)
date added to LUP
2016-04-05 07:24:23
date last changed
2017-02-12 04:31:39
@article{550668b4-75f7-4567-83f3-72a9d141e631,
  abstract     = {<p>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.</p>},
  author       = {Kronvall, Erik and Valdemarsson, Stig and Säveland, Hans and Nilsson, Ola G.},
  issn         = {1878-8750},
  keyword      = {Growth hormone deficiency,Hypopituitarism,Outcome,Pituitary deficiency,Subarachnoid hemorrhage},
  language     = {eng},
  number       = {3-4},
  pages        = {529--537},
  publisher    = {Elsevier},
  series       = {World Neurosurgery},
  title        = {Pituitary dysfunction after aneurysmal subarachnoid hemorrhage is associated with impaired early outcome},
  url          = {http://dx.doi.org/10.1016/j.wneu.2013.10.038},
  volume       = {81},
  year         = {2014},
}