Background and Purpose -To investigate the incidence, pattern, and magnitud e of neuroendocrine changes in long-term survivors of aneurysmal subarachnoid hemorrhage (SAH)-. Methods -Thirty patients (16 women) with a m...Background and Purpose -To investigate the incidence, pattern, and magnitud e 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 aneury smal SAH. SAH severity was graded clinically by the Hunt & Hess scale (median, II) and ra diologically by the Fisher classification (median, II). Patients underwent measu rement of basal hormone levels and dynamic assessment by the low-dose (1 μ g) corticotropin stimulation test. Functional outcome was examined concurrently wi th endocrine testing by the modified Rankin Scale and the Barthel Index. Results -Of the 30 patients tested, 14 patients (47% ) showed isolated or combined e ndocrine 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 observe d in 7% of patients. Median modified Rankin Scale and Barthel Index at the tim e of endocrine testing were 1 and 100, respectively. There was no correlation be tween the presence of endocrine dysfunction and SAH severity indices or function al outcome scores. Conclusions -Long-term survivors of aneurysmal SAH freque ntly exhibit endocrine changes, with growth hormone and gonadal deficiencies pre dominating. Thus, screening of pituitary function is recommended in patients sur viving SAH. The relationship between late hormonal alterations and functional ou tcome in patients with SAH warrants further study.展开更多
文摘Background and Purpose -To investigate the incidence, pattern, and magnitud e 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 aneury smal SAH. SAH severity was graded clinically by the Hunt & Hess scale (median, II) and ra diologically by the Fisher classification (median, II). Patients underwent measu rement of basal hormone levels and dynamic assessment by the low-dose (1 μ g) corticotropin stimulation test. Functional outcome was examined concurrently wi th endocrine testing by the modified Rankin Scale and the Barthel Index. Results -Of the 30 patients tested, 14 patients (47% ) showed isolated or combined e ndocrine 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 observe d in 7% of patients. Median modified Rankin Scale and Barthel Index at the tim e of endocrine testing were 1 and 100, respectively. There was no correlation be tween the presence of endocrine dysfunction and SAH severity indices or function al outcome scores. Conclusions -Long-term survivors of aneurysmal SAH freque ntly exhibit endocrine changes, with growth hormone and gonadal deficiencies pre dominating. Thus, screening of pituitary function is recommended in patients sur viving SAH. The relationship between late hormonal alterations and functional ou tcome in patients with SAH warrants further study.
