Pituitary functions in patients with chronic subdural hematoma
Mikulas Kosak1, Vaclav Masopust2, David Netuka2, Zdenka Lacinova1, Michal Krsek1, Josef Marek1 & Vaclav Hana1
Certain degree of hypopituitarism has been revealed in a significant number of patients who suffered traumatic brain injuries or subarachnoid hemorrhage. Microhemorrhages, necrosis, tissue infarcts and vasoconstriction are reported as mechanism of hypothalamo-pituitary dysfunction. Assessment of hypothalamo-pituitary endocrine functions in patients with chronic subdural hematomas has not been published yet, although dysfunction of hypothalamo-pituitary unit can be expected (head trauma, compression and oedema of the brain with shifting of the midline structures.
Aims: Evaluation of the pituitary functions in patients with chronic subdural hematoma immediately after surgical treatment and during 1 year follow-up.
Patients and methods: We have examined 22 patients (17 men, 5 women, 5186 years old, mean 70.6±S.D. 9.8 years) so far. Twelve patients (9 men/3 women) have been examined prospectively (prospective group) and 10 patients (8 men/2 women) were tested only 12 months after the operation (retrospective group). In the prospective group the patients in the first days after evacuation of the hematoma and then 3 and 12 months after the operation are being tested. Basal levels of pituitary hormones and hormones of dependent peripheral glands, plasma cortisol during 250 μg tetrasoactrin (Synacthen) test, GH after GHRH+arginin stimulation and TSH after TRH stimulation are assesed.
Results: In the acute phase, central hypogonadism was diagnosed in four male patients among the prospectively followed patients. In three of them gonadotrophic axis normalised within 3 months after the operation (one patient hasnt been retested yet). In one patient partial hypocorticalism and central hypogonadism have developed after 3 months. In the retrospective group central hypogonadism was diagnosed in one patient.
Conclusions: Preliminary data from our group of patients show that chronic subdural hematoma may be accompanied with a partial pituitary dysfunction and that it can develop even with a time delay. Further evaluation of a larger group is necessary.
The project is supported by a grant of Czech Ministry of Health NS 9794 4.