Endocrine Abstracts

Background: SAH is a significant cause of morbidity and mortality. Survivors report long term psychological distress, sleep disturbance, libido changes and fatigue. Previous studies describe an increased incidence of hypopituitarism.

Hypothesis: Evaluation of psychological symptoms and clinical and radiological features of SAH could predict the incidence of hypopituitarism.

Patients and Methods: 102 post-interventional SAH survivors ((76 male) mean age (range) 50.7 (22–72) years) were studied. Mean time from ictus 21.2 (minimum 12) months. Patients had basal pituitary and glucagon stimulation testing and completed Hospital Acquired Depression Scale (HADS), Davidson Trauma Score (DTS) and WHO Quality of Life (WHOQoL) questionnaires. Radiologic features at presentation (location, severity, Fisher grade) and clinical features (WFNS-SAH grade, intervention modality, presence of hydrocephalus, EVD insertion) were recorded.

Results: 49 of 102 participants had pituitary insufficiency. 32 had GH peak below 9 ng/ml post 1 mg s/c Glucagon. 23 had severe GH deficiency (peak <3 ng/ml).

There was no increased incidence of anxiety, depression or post-traumatic stress disorder (PTSD) in the GH deficient cohort.

Site of aneurysm and Fisher grade did not predict the incidence of GHD. Neither clinical assessment of severity at presentation nor development of hydrocephalus requiring an EVD correlated with incidence of GHD.

There was an increased incidence of hypopituitarism in the endovascular coiled (EV) cohort vs surgical clipping.

Discussion: These results suggest that the incidence of hypopituitarism in this population is high (48%) and the incidence of severe GHD (NICE treatment cut-off) was 22.5%. Further studies are required to determine the benefit of replacement in these patients. While there was no increased incidence of psychological morbidity, GH replacement may improve these symptoms in the GHD group.

The higher incidence of hypopituitarism in EV vs clipping may be explained in part by the higher number of EV (79 vs 23) but requires further evaluation.