1. Pituitary Dysfunction After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis
- Author
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Anil Can, Clemens M F Dirven, Rose Du, Ruben Dammers, Edward R. Laws, Whitney W. Woodmansee, Timothy R. Smith, Bradley A. Gross, and Neurosurgery
- Subjects
medicine.medical_specialty ,Subarachnoid hemorrhage ,Diabetes insipidus ,030209 endocrinology & metabolism ,Hypopituitarism ,Hypogonadotropic hypogonadism ,Gastroenterology ,Growth hormone deficiency ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Prevalence ,Humans ,Medicine ,business.industry ,Insulin tolerance test ,Subarachnoid Hemorrhage ,Growth hormone–releasing hormone ,medicine.disease ,Surgery ,Neurology (clinical) ,business ,Complication ,Secondary hypothyroidism ,030217 neurology & neurosurgery ,Secondary adrenal insufficiency - Abstract
Background The prevalence of hypothalamic-pituitary dysfunction after aneurysmal subarachnoid hemorrhage has not been precisely determined, and conflicting results have been reported in the literature. Objective To perform a systematic review and meta-analysis investigating the prevalence of pituitary insufficiency after aneurysmal subarachnoid hemorrhage and to focus on basal serum and dynamic test differences. Methods The prevalence of pituitary dysfunction was quantified at 3 to 6 months and >6 months after aneurysmal subarachnoid hemorrhage. Proportions were transformed with the logit transformation. A subgroup analysis was performed focusing on the differences in outcome between basal serum and dynamic tests for the diagnosis of growth hormone deficiency (GHD) and secondary adrenal insufficiency. Results Overall prevalence of hypopituitarism differed considerably between studies, ranging from 0.05 to 0.45 in studies performed between 3 and 6 months after the event and from 0 to 0.55 in long-term studies (>6 months), with pooled frequencies of 0.31 (95% confidence interval [CI]: 0.22-0.43) and 0.25 (95% CI: 0.16-0.36), respectively. Pooled frequency of GHD at 3 to 6 months was 0.14 (95% CI: 0.08-0.24). At >6 months, GHD prevalence was 0.19 (95% CI: 0.13-0.26) overall, but ranged from 0.15 (95% CI: 0.06-0.33) with the insulin tolerance test to 0.25 (95% CI: 0.15-0.36) using the growth hormone releasing hormone + arginine test. Conclusion Hypopituitarism is a common complication in patients with aneurysmal subarachnoid hemorrhage, with GHD being the most prevalent diagnosis. We showed that variations in prevalence rates in the literature are partly due to methodological differences among pituitary function tests. Abbreviations ACTH, adrenocorticotropic hormoneaSAH, aneurysmal subarachnoid hemorrhageGHD, growth hormone deficiencyGHRH, growth hormone-releasing hormoneGST, glucagon stimulation testIGF, insulin-like growth factor 1ITT, insulin tolerance testSAH, subarachnoid hemorrhage.
- Published
- 2016