Endocrine Abstracts (2006) 11 P128

Time course of neuroendocrine dysfunction after aneurysmal subarachnoid hemorrhage – need for reassessment even years after the hemorrhage?

A Reineke, E Poll, S Levasseur, E Yagmur, JM Gilsbach & I Kreitschmann-Andermahr

University of Technology, RWTH, Aachen, Germany.

In recent years there has been increasing evidence for neuroendocrine dysfunction as a sequel of aneurysmal subarachnoid hemorrhage (SAH). One investigation has assessed pituitary function in SAH-survivors in a longitudinal design 3 and 12 months after the hemorrhage, but nothing is known about the dynamics of the hypothalamo-pituitary axis in the years following the bleeding. We present the data of 5 patients who had sustained aneurysmal SAH and had undergone their first endocrinological evaluation at least one year after the acute event and were reassessed on average three years later because of partial pituitary deficiency already determined in the first investigation. The insulin tolerance test (ITT) was used for assessing corticotroph and somatotroph function. Additionally, TSH, fT4, fT3, FSH, LH, estradiol (females), testosterone (males) and prolactin were measured. Severe growth hormone deficiency (GHD) was diagnosed if peak GH levels were <3 μg/l and secondary hypocortisolism if peak cortisol levels were <500 nmol/ in the ITT. Based on the ITT criteria 5/5 patients were diagnosed with ACTH deficiency and 2/5 patients with severe GHD in the first and also the second test. Interestingly, basal and stimulated cortisol and ACTH levels were lower at follow-up in all investigated patients, reaching statistical significance in the Wilcoxon-test. Maximal stimulated GH levels were also lower at follow-up in all investigated patients, basal GH levels were lower in 4 of 5 patients. Secondary hypogonadism or secondary hypothyroidism was not observed in the patient group. As the result of the second testing 3 of the patients with corticotroph deficiency were offered hydrocortisone substitution because of stimulated cortisol levels below 300 nmol/l. Our data give preliminary evidence that worsening of neuroendocrine function may occur in SAH patients even years after the hemorrhage and that renewed endocrine function testing has therapeutic implications.

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