Prevalence of Pituitary Deficiency in Patients after Aneurysmal Subarachnoid Hemorrhage
Ilonka Kreitschmann-Andermahr,
Christine Hoff,
Bernhard Saller,
Sandra Niggemeier,
Sabine Pruemper,
Bernd O. Hütter,
Veit Rohde,
Axel Gressner,
Siegfried Matern and
Joachim M. Gilsbach
Department of Neurosurgery (I.K.-A., S.N., S.P., V.R., J.M.G.), Endocrine Outpatient Clinic (C.H., S.N., S.M.), Department of Internal Medicine III, Department of Medical Psychology and Sociology (B.O.H.), Institute for Clinical Chemistry and Pathobiochemistry (A.G.), University Hospital Aachen, D-52074 Aachen, Germany; and Pfizer GmbH (B.S.), D-76032 Karlsruhe, Germany
Address all correspondence and requests for reprints to: Dr. Ilonka Kreitschmann-Andermahr, University Hospital Aachen, Department of Neurosurgery, Pauwelsstrasse 30, 52074 Aachen, Germany. E-mail: ilonka.kreitschmann{at}post.rwth-aachen.de.
After aneurysmal subarachnoid hemorrhage (SAH), patients frequentlypresent with persistent bodily, psychosocial, and cognitiveimpairments that resemble those of patients with untreated partialor complete pituitary insufficiency. Because of these similarities,the authors hypothesized that aneurysmal SAH may cause pituitarydysfunction. Pituitary function testing was performed in 40aneurysmal SAH patients between 12 and 72 months after the SAH.A combined TRH-LHRH-arginine test and the insulin tolerancetest were performed on two separate days. Only 18 of 40 (45%)of the tested patients had normal pituitary function. Five of40 exhibited isolated severe GH deficiency (GHD), and an additionalthree of 40 had severe GHD plus corticotroph deficiency. Isolatedcorticotroph deficiency was seen in 13 of 40 patients, and onepatient showed isolated thyrotroph deficiency. All but one patientwith corticotroph insufficiency were female. Patients with severeGHD had gained significantly more weight since their SAH thanpatients without GHD and exhibited a significantly higher bodymass index. None of the clinical parameters indicative of apoor neurological outcome in aneurysmal SAH were related topituitary insufficiency. In summary, neuroendocrine dysfunctionwas identified in a substantial portion of patients with previousaneurysmal SAH and should be borne in mind as a potential long-termsequel of the illness.
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