Hypopituitarism is a known complication of traumatic brain injury and subarachnoidal bleeding. There are few data about pituitary dysfunction as a complication of cerebral ischemia. This study aimed to investigate this issue. We investigated the prevalence of pituitary dysfunction in patients with cerebral ischemia (a. cerebri media: n=19, thalamus: n=4 multiinfarction syndrome: n=17) NIHSS varied between 18. 40 patients, 23 males and 17 females, (mean age f: 60 years; m: 62.5 years; range 2681 years) with a stroke 1234 weeks prior to the study (median 20.5 weeks) underwent clinical examination, basal and combined releasing hormone testing (CRH, GHRH, LHRH) of the pituitary gland, including TSH, free T4/T3, testosterone (males), estradiol (females), LH, FSH, cortisol, ACTH, GH, IGF 1, IGF-BP3 and depression testing. Growth hormone deficiency (GHD) was defined as a GH response <6 ng/ml to GHRH. Secondary adrenal insufficiency was defined as cortisol response <18.1 μg/dl to CRH. Pituitary deficiency was found in 67.5% (27/40) of the patients, 24 with one dysfunctional axis and 3 with 23 dysfunctional axes. 26/37 (70.3%) had GHD (13<65 years, 13>65 years). 2/40 (1 male, 1 female) had secondary hypogonadism (total testosterone <241 ng/dl and estradiol <30 pg/ml and low gonadotropins). 5/40 patients had corticotrope insufficiency (2 complete, 3 stress insufficiency) and none had TSH-deficiency. HADS testing was highly positive (>10) for depression in 24/40 (60%) and positive (810) in 5/40 (12.5%) patients. In summary we found pituitary dysfunction in 67.5% of patients with predominantly GHD (in 13 patients maybe due to age). These findings strongly suggest that patients who suffer from stroke should routinely undergo pituitary testing.
03 - 07 May 2008
European Society of Endocrinology