Artikel
Effects of sex steroids levels on outcome and occurrence of vasospasm after aneurysmal subarachnoid hemorrhage
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Autoren
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A. Hoellig
- Neurosurgical Department, RWTH Aachen University
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M. Aberfeld
- University Bonn
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B.S. Stoffel-Wagner
- Institutes of Clinical Chemistry and Clinical Pharmacology, University Clinics Bonn
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H. Clusmann
- Neurosurgical Department, RWTH Aachen University
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: To evaluate the relationship between baseline levels of sex steroids, the outcome and the occurrence of vasospasm after aneurysmal subarachnoid hemorrhage (aSAH).
Methods: Prospective clinical study with evaluation of the baseline serum levels of Testosterone (TES), 17-β-Estradiol (ES) (in female subgroup) and dehydroepiandosterone sulfate (DHEAS) the day of admissions and correlation with outcome at discharge according to modified Rankin Scale (mRS) and the occurrence of vasospasm/delayed neurological deficit (DIND) either defined by a new neurological deficit with amelioration to induced hypertension or new neurologic deficit with detection of vasospasm by angiography.
Results: In a group of 75 (47 female, 28 male) patients with aSAH with a mean age of 55.5 (± 13.5) years at admission levels of TES, ES and DHEAS were measured. During the further course in 20 (16 female, 4 male) patients vasospasm/DIND was detected. Neither hormone levels at admission nor the ratios TES/DHEAS nor ES/DHEAS were significant predictors of the occurrence of vasospasm within the further course. No single hormone level emerged as a predictor of outcome, but in the female group the ratio ES/DHEAS was a significant prognostic parameter of outcome (p < 0.05). In the male group age did predict worse outcome, whereas in the female subgroup age was not a prognostic factor.
Conclusions: Sex Steroids are proposed to own a neuroprotective effect; estradiol has been shown to attenuate vasospasm after experimental aSAH. However, baseline sexual steroids did not predict outcome or occurrence of vasospasm, but the ratio ES/DHEAS is a significant prognostic parameter indicating the possible importance of a certain sex steroid balance. The relationship between age and outcome only was shown in the male subgroup but not in the female subgroup underlining the clinical impression of younger female patients being the most susceptible collective for complications after aSAH in a reverse conclusion.
