The Forgetten Axis-Hidden Neuroendocrine Sequelae Of Aneurysmal Subarachnoid Hemorrhage
Keywords:
There is an increased incidence of neuroendocrine dysfunction following aneurysmal SAH (aSAH), mostly during the acute phase. Multiple pituitary hormone deficiencies and single-axis pituitary dysfunction were noted in 36% and 32% of patients, respectively. The most common pituitary hormone deficiency following aSAH was growth hormone (48%), followed by adreno-corticotrophic hormone, gonadotropins (LH/FSH), and thyroid stimulating hormone and prolactin deficiency. In the clinical management of aSAH, clinical outcome benefits from the evaluation of hormonal statusAbstract
Background and Aim: In the treatment of Aneurysmal Subarachnoid Hemorrhage (aSAH), endocrine dysfunction is rarely given adequate attention. Nevertheless, neuroendocrine disturbances, particularly involving the pituitary gland, occur frequently after aSAH and can cause lasting issues such as impaired cognition and diminished quality of life. While hypopituitarism following SAH may present with vague or subtle signs, missing the diagnosis can lead to serious health risks.
Methods and Materials/Patients: This prospective study aimed to investigate the frequency and characteristics of neuroendocrine changes in patients with acute aneurysmal subarachnoid hemorrhage (aSAH). It included 35 patients who presented within seven days of symptom onset. Comprehensive endocrine evaluations were conducted to assess potential dysfunction across various pituitary axes, including the somatotropic, gonadotropic, corticotropic, thyrotropic axes, as well as prolactin levels.
Results: A total of 35-SAH cases (10 males and 25 females; mean age was 56.24 years) were included in the study. Aneurysms were more commonly found in the anterior circulation (n=30) than in the posterior circulation (n=5). Most of the patients presented with the Hunt-Hess grade of 1, followed by grades 3, 2, and 4, respectively. Growth hormone deficiency (48%) was the most common pituitary dysfunction, followed by adrenocorticotrophic hormone (24%), gonadotropins (FSH & LH) (24%), and thyroid stimulating hormone (16%) deficiencies and prolactin deficiency (10%) respectively. Single pituitary axis neuroendocrine dysfunction was noted in 14 patients (40%) and multiple pituitary axes dysfunction was observed in 11 patients (31.5%). Overall, 25 patients (71.5%) had neuroendocrine dysfunction in single or multiple pituitary hormone axes.
Conclusion: Neuroendocrine dysfunction in acute aSAH is 71.5%. Accordingly, 40% of the participants had single-axis pituitary dysfunction and 31.5% had multiple axes pituitary dysfunction. The most common endocrine dysfunction was growth hormone deficiency (48%), followed by adrenocorticotrophic hormone, gonadotropins (LH & FSH), and thyroid stimulating hormone. Therefore, it is suggested to include hormonal evaluation in the management of acute SAH for better clinical outcomes.
