gms | German Medical Science

Objective: Hypothalamo-putary insufficiency is increasingly recognized as a sequel of subarachnoid hemorrhage. We sought to define the incidence, risk factors and the consequences of chronic hormonal deficiencies after SAH.

Methods: About 500 patients, who were successfully treated for SAH between 2001 and 2007 in two main German neurosurgical centres, are systematically recruited for endocrine assessment in a third independent institute. Till October 2008 35 patients (21 women) with a mean age of 53±10 years underwent endocrine assessment after spontaneous SAH. SAH severity was graded clinically by the Hunt & Hess scale and all patients had a Glasgow outcome scale of at least 4. Patients underwent measurement of basal hormone levels and dynamic assessment by the insulin tolerance test. In seven patients the insulin tolerance test was not performed because of refusal or because of contraindications like chronic epilepsy.

Results: 8 patients (22%) showed endocrine abnormalities. These included growth hormone deficiency in 2, hypogonadism in 5 and thyroid dysfunction in 1 patient respectively. Previous poor SAH grade was present in 4 patients with endocrine abnormalities, vasospasm in 4 and shunt-dependent hydrocephalus in 3. Aneurysm location included communicating anterior aneurysm in 2 patients, carotid artery aneurysm in 2, and media bifurcation aneurysm in 1. In 2 patients no aneurysm could be detected.

Till now no significant correlation was found regarding sex, age, SAH grade, vasospasm and aneurysm location.

Conclusions: In summary, neuroendocrine dysfunction was identified in a substantial portion of patients with previous SAH. Further investigations are necessary to assess risk factors and prevention strategies. Furthermore follow up should be performed to assess therapeutic strategies to improve the overall clinical improvement of patients after SAH.