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Hypopituitarism is uncommon after aneurysmal subarachnoid haemorrhage

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Summary Objective 

Aneurysmal subarachnoid haemorrhage (SAH) has recently been reported as a common cause of chronic hypopituitarism, and introduction of routine neuroendocrine screening has been advocated. We aimed at estimating the risk of hypopituitarism after SAH using strict criteria including confirmatory testing in case of suggested insufficiency. Design 

Cross-sectional evaluation with a nested prospective subgroup. Patients and measurements 

Endocrine evaluation was performed at a median of 14 months (range 11–26) post-SAH in 62 patients with SAH and 30 healthy controls. Twenty-six patients were followed prospectively (median 7 days, and 12 months post-SAH). Endocrine evaluation included baseline evaluation, which was combined with an insulin tolerance test (ITT) or, if contraindicated, GHRH + arginine tests and a standard ACTH test at evaluation 1–2 years post-SAH. Pituitary insufficiencies were confirmed by re-evaluation. Results 

Early post-SAH hormone alterations mimicking central hypogonadism were present in 58% of the patients and associated with a worse clinical state (P < 0ยท05). One to 2 years post-SAH, initial neuroendocrine evaluation identified seven patients (11%) with abnormal results; three had free T4 and TSH suggestive of central hypothyroidism, three men had testosterone below 10 nm, and one had an insufficient GH and cortisol response to the ITT. None of these abnormalities was confirmed upon confirmatory testing. Conclusion 

In the largest reported cohort of patients with SAH to date, with early and late endocrine evaluation, none of the patients had chronic hypopituitarism. Based on these findings, the introduction of routine neuroendocrine screening is not justified, and the data suggest the importance of using strict diagnostic criteria in patients with a low pretest probability of hypopituitarism.
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Document Type: Research Article

Affiliations: 1: Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet 2: Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet 3: Department of Radiology Copenhagen University Hospital, Rigshospitalet, Denmark

Publication date: July 1, 2010

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