This Article Full Text Full Text (PDF) All Versions of this Article: 35/12/2884    most recent 01.STR.0000147716.45571.45v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dimopoulou, I. Articles by Tsagarakis, S. Search for Related Content PubMed PubMed Citation Articles by Dimopoulou, I. Articles by Tsagarakis, S. Pubmed/NCBI databases Medline Plus Health Information Endocrine Diseases Hormones Related Collections Cerebral Aneurysm, AVM, & Subarachnoid hemorrhage

(Stroke. 2004;35:2884.)
© 2004 American Heart Association, Inc.

Original Contributions

High Incidence of Neuroendocrine Dysfunction in Long-Term Survivors of Aneurysmal Subarachnoid Hemorrhage

Ioanna Dimopoulou, MD; Andreas T. Kouyialis, MD; Marinella Tzanella, MD; Apostolos Armaganidis, MD; Nikolaos Thalassinos, MD; Damianos E. Sakas, MD Stylianos Tsagarakis, MD

From the Departments of Critical Care Medicine (I.D., A.A.), Neurosurgery (A.T.K., D.E.S.), and Endocrinology, Diabetes, and Metabolism (M.T., N.T., S.T.), Evangelismos Hospital, National & Kapodistrian University of Athens, Medical School, Athens, Greece.

Correspondence to Dr Ioanna Dimopoulou, Assistant Professor in Critical Care Medicine, 2 Pesmazoglou Street, 14561 Kifissia, Athens, Greece. E-mail idimo{at}otenet.gr

Background and Purpose— To investigate the incidence, pattern, and magnitude of neuroendocrine changes in long-term survivors of aneurysmal subarachnoid hemorrhage (SAH).

Methods— Thirty patients (16 women) with a mean age of 50±13 years underwent endocrine assessment between 12 and 24 months after aneurysmal SAH. SAH severity was graded clinically by the Hunt & Hess scale (median, II) and radiologically by the Fisher classification (median, II). Patients underwent measurement of basal hormone levels and dynamic assessment by the low-dose (1 µg) corticotropin stimulation test. Functional outcome was examined concurrently with endocrine testing by the modified Rankin Scale and the Barthel Index.

Results— Of the 30 patients tested, 14 patients (47%) showed isolated or combined endocrine abnormalities. These included low insulin-like growth factor 1 levels compatible with growth hormone deficiency in 37%, hypogonadism in 13%, and cortisol hyporesponsiveness to the low-dose corticotropin stimulation test in 10%; thyroid dysfunction in the form of subclinical hypothyroidism was observed in 7% of patients. Median modified Rankin Scale and Barthel Index at the time of endocrine testing were 1 and 100, respectively. There was no correlation between the presence of endocrine dysfunction and SAH severity indices or functional outcome scores.

Conclusions— Long-term survivors of aneurysmal SAH frequently exhibit endocrine changes, with growth hormone and gonadal deficiencies predominating. Thus, screening of pituitary function is recommended in patients surviving SAH. The relationship between late hormonal alterations and functional outcome in patients with SAH warrants further study.

Key Words: aneurysmal • endocrine alterations • outcome • subarachnoid hemorrhage

This article has been cited by other articles:

				H. J. Schneider, I. Kreitschmann-Andermahr, E. Ghigo, G. K. Stalla, and A. Agha Hypothalamopituitary Dysfunction Following Traumatic Brain Injury and Aneurysmal Subarachnoid Hemorrhage: A Systematic Review JAMA, September 26, 2007; 298(12): 1429 - 1438. [Abstract] [Full Text] [PDF]

				A. B. Storrow, K. Wrenn, K. de Gans, M. D. Vergouwen, Y. B. Roos, M. Sherlock, A. Agha, C. J. Thompson, N. A. Tritos, J. I. Suarez, et al. Aneurysmal subarachnoid hemorrhage. N. Engl. J. Med., April 20, 2006; 354(16): 1755 - 1757. [Full Text] [PDF]

				I. Kreitschmann-Andermahr, J. M. Gilsbach, I. Dimopoulou, and S. Tsagarakis Diagnosing Growth Hormone Deficiency After Aneurysmal Subarachnoid Hemorrhage * Response: Stroke, May 1, 2005; 36(5): 931 - 932. [Full Text] [PDF]