Long-Term Follow-Up of Anterior Pituitary Deficiency after Aneurysmal Subarachnoid Hemorrhage: Prospective Cohort

• Published in: Journal of stroke and cerebrovascular diseases Vol. 25; no. 10; pp. 2405 - 2414
• Main Authors: Vieira, Gerival, MD, de Albuquerque, Lucas Alverne Freitas, MD, de Avellar, Ariane Bernardes Camilo Castilho, MD, Pereira, Julio Leonardo Barbosa, MD, Dellaretti, Marcos, PhD, Miranda, Paulo Augusto Carvalho, PhD, Macedo, Rodrigo Alvares Paiva, MD, da Silva, Laura Amaral Quintino, MD, Gusmão, Sebastião Nataniel Silva, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2016
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - epidemiology; Aneurysm, Ruptured - therapy; Angiography, Digital Subtraction; Brazil - epidemiology; Cardiovascular; Cerebral Angiography - methods; Computed Tomography Angiography; Female; Follow-Up Studies; Humans; hypopituitarism; Hypopituitarism - diagnosis; Hypopituitarism - epidemiology; Hypopituitarism - physiopathology; Incidence; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - epidemiology; Intracranial Aneurysm - therapy; intracranial aneurysms; Male; Middle Aged; Neurology; pituitary anterior lobe; Pituitary Function Tests; Pituitary Gland, Anterior - physiopathology; Predictive Value of Tests; Prevalence; Prospective Studies; Risk Factors; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - epidemiology; Subarachnoid Hemorrhage - therapy; Time Factors; Treatment Outcome; Young Adult; intracranial aneurysms; pituitary anterior lobe; hypopituitarism; Subarachnoid hemorrhage
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.011

Objective The aim of this study was to evaluate the prevalence of hypopituitarism in the acute stage after aneurysmal subarachnoid hemorrhage (SAH) as well at the chronic stage, at least 1 year after bleeding, to assess its implications and correlation with clinical features of the studied population. Patients and Methods This was a prospective cohort study that evaluated patients admitted between December 2009 and May 2011 with a diagnosis of SAH secondary to cerebral aneurysm rupture. Clinical and endocrine assessment was performed during the acute stage after hospital admission and before treatment at a mean of 7.5 days (SD ± 3.8) following SAH, and also at the follow-up visit at a mean of 25.5 months (range: 12-55 months) after the bleeding. Results Out of the 119 patients initially assessed, 92 were enrolled for acute stage, 82 underwent hormonal levels analysis, and 68 (82.9%) were followed up in both acute and chronic phases. The mean age and median age were lower among patients with dysfunction in the acute phase compared to those without dysfunction ( P  < .05). The prevalence of dysfunction in the acute phase was higher among patients with hydrocephalus on admission computed tomography (57.9%) than among those without it ( P  < .05). At chronic phase, there was an association between dysfunction and Hunt & Hess scale score greater than 2 ( P  < .05). Conclusions We believe that there is not enough literature evidence to incorporate routine endocrinological evaluation for patient victims of SAH, but we should always keep this differential diagnosis in mind when conducting long-term assessments of this population.