Endocrine Abstracts (2009) 20 P554

Screening for neuroendocrine dysfunction in patients after spontaneous subarachnoid hemorrhage

Sandra Pekic Djurdjevic1, Vladimir Jovanovic2, Marko Stojanovic1, Branko Djurovic2, Mirjana Doknic1, Dragana Miljic1, Marina Nikolic-Djurovic1 & Vera Popovic1

1Institute of Endocrinology, University Clinical Center, Belgrade, Serbia; 2Institute of Neurosurgery, University Clinical Center, Belgrade, Serbia.

Spontaneous subarahnoid hemorrhage (SAH) is a recently identified risk factor for hipopituitarism, especially growth hormone (GH) and corticotroph deficiencies. The aim of this study is to perform the initial screening procedure to identify the patients with increased risk of neuroendocrine dysfunction after SAH in the chronic phase and to identify the possible predictor(s) for neuroendocrine dysfunction. Ninety-one patients (30 males, 61 females), age between 19 and 69 years (48.0±1.1 years), with BMI 24.7±0.5 kg/m2 and good outcome (GOS 4.6±0.6) were tested 1.8±0.2 years after SAH. Some patients experienced vasospasm (VS, n=18) and/or hydrocephalus (HDC, n=9) during acute SAH. At baseline, serum samples for insulin-like growth factor I (IGF-I), thyroxine (T4), TSH, FSH, LH, testosterone (in males), estradiol (in females), prolactin and cortisol were taken.

During screening procedure, according to the baseline hormonal evaluation, 42 of 91 (46.2%) had normal pituitary function. Eleven SAH patients (12.1%) had multiple pituitary hormone abnormalities, with two pituitary axes affected in 10, and three pituitary axes affected in one patient. Thirty-eight SAH patients (41.7%) were diagnosed as isolated pituitary hormone abnormality. A total of 25 SAH patients (27.5%) exhibited low IGF-I level, indicating the need for GH provocative testing for diagnosis of GH deficiency (GHD); in fifteen as an isolated abnormality and in additional 10 patients combined with other pituitary hormone abnormalities. Eighteen SAH patients (19.8%) exhibited low morning cortisol level (in 12 patients as an isolated abnormality). Low TSH and T4 levels were seen in two patients. Two of 30 males and three of 61 female patients had gonadotroph deficiency, in one female combined with other pituitary hormone abnormalities. Hyperprolactinemia was diagnosed in 3 patients. The VS and HCT during acute phase of SAH were related to abnormal pituitary hormonal testings – VS with low IGF-I levels and HCT with low cortisol levels.

In summary, during initial screening procedure, neuroendocrine dysfunction was identified in a substantial portion of patients with previous SAH and some predictor factors for these abnormalities were identified. Further pituitary function testings are mandatory in these patients.

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