gms | German Medical Science

Objective: QoL is an important outcome criterion in clinical research and is used to monitor treatment effects. Patients, who have sustained SAH oftentimes have impaired QoL as do patients with untreated hypopituitarism. Considering the high degree of partial hypopituitarism in SAH survivors, we sought to elucidate the impact of neuroendocrine dysfunction on QoL and the prevalence of psychiatric sequelae in these patients.

Methods: QoL, depression and PTSD symptoms were assessed in 40 SAH survivors who had undergone endocrine function testing at least one year after the hemorrhage. QoL was assessed using the Nottingham Health Profile (NHP), QoL-AGHDA and SF-36. The Beck Depression Inventory and the Impact of Event Scale were used to evaluate depression and PTSD symptoms, respectively. Severe growth hormone deficiency (GHD) and secondary ACTH deficiency were diagnosed by peak GH levels of <3 µg/l and by peak cortisol levels of <500 nmol/l in the insulin tolerance test, respectively. Diagnoses of secondary hypothyroidism and/or hypogonadism were based on basal hormone levels.

Results: Neither ACTH deficiency (n=16) nor total number of patients with any hormone deficit (n=22) were associated with a worse QoL, more severe depression or PTSD as compared to the other SAH patients. Severe GHD (n=8) was associated with a significantly worse QoL in the NHP subscale energy. In a stepwise multiple regression analysis, basal cortisol level was included as the first and oftentimes only predictor for several psychological QoL domains and depression, whereas physical aspects of QoL were predicted primarily by bodily recovery from the SAH. These results indicate a strong association between low morning cortisol levels and impaired psychosocial well-being in SAH patients.

Conclusions: From these studies, we conclude that neuroendocrine dysfunction plays a role in the pathology of reduced QuoL and depression in SAH patients.