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

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• 作者：Gerival Vieira Jr ; MD^* ; ^&dagger ; ; ^{vieiragjr@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Lucas Alverne Freitas de Albuquerque ; MD^* ; Ariane Bernardes Camilo Castilho de Avellar ; MD^* ; Julio Leonardo Barbosa Pereira ; MD^* ; Marcos Dellaretti ; PhD^* ; ^&Dagger ; ; Paulo Augusto Carvalho Miranda ; PhD^§ ; ; Rodrigo Alvares Paiva Macedo ; MD^&Dagger ; ; Laura Amaral Quintino da Silva ; MD^&Dagger ; ; Sebastiã ; o Nataniel Silva Gusmã ; o ; PhD^&dagger ;
• 关键词：Subarachnoid hemorrhage ; intracranial aneurysms ; pituitary anterior lobe ; hypopituitarism
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：25
• 期：10
• 页码：2405-2414
• 全文大小：708 K

文摘

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.