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Published on: August 30, 2020
Pituitary Dysfunction After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis
Anil Can1, Bradley A Gross, Timothy R Smith
1*Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; ‡Harvard Medical School, Boston, Massachusetts; §Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands; ¶Division of Endocrinology, Brigham and Women's Hospital, Boston, Massachusetts.
Hypopituitarism is a frequent complication after aneurysmal subarachnoid hemorrhage (aSAH), with growth hormone deficiency (GHD) being most common. Methodological differences in pituitary function tests contribute to varied prevalence rates in studies.
Area of Science:
- Endocrinology
- Neuroscience
- Critical Care Medicine
Background:
- Hypothalamic-pituitary dysfunction is a known complication following aneurysmal subarachnoid hemorrhage (aSAH).
- Previous studies report conflicting prevalence rates for pituitary insufficiency after aSAH.
- Precise determination of pituitary dysfunction prevalence remains a challenge.
Purpose of the Study:
- To systematically review and meta-analyze the prevalence of pituitary insufficiency post-aSAH.
- To investigate differences in prevalence based on basal serum versus dynamic testing.
- To specifically examine growth hormone deficiency (GHD) and secondary adrenal insufficiency.
Main Methods:
- Systematic review and meta-analysis of studies quantifying pituitary dysfunction.
- Prevalence data collected at 3-6 months and >6 months post-aSAH.
- Subgroup analysis comparing basal serum and dynamic tests for GHD and adrenal insufficiency diagnosis.
Main Results:
- Pooled prevalence of hypopituitarism was 0.31 (95% CI: 0.22-0.43) at 3-6 months and 0.25 (95% CI: 0.16-0.36) long-term.
- Pooled GHD prevalence was 0.14 (95% CI: 0.08-0.24) at 3-6 months and 0.19 (95% CI: 0.13-0.26) long-term.
- GHD diagnosis varied based on testing method (ITT vs. GHRH+arginine).
Conclusions:
- Hypopituitarism is a common sequela of aSAH, with GHD being the most frequent diagnosis.
- Prevalence rate variations in the literature are partly attributable to differences in pituitary function testing methodologies.
- Standardized diagnostic approaches are crucial for accurate assessment of pituitary function post-aSAH.
