Anterior Pituitary Hypofunction Following Aneurysmal Subarachnoid Hemorrhage: An Overlooked Clinical Syndrome
Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v6i3.4415
Abstract
Subarachnoid hemorrhage (SAH) is a prevalent hemorrhagic cerebrovascular condition, often accompanied by complex and serious complications such as cerebral vasospasm, disseminated intravascular coagulation (DIC), cerebral edema, hydrocephalus, epilepsy, aneurysm rupture and re-hemorrhage, intractable hyponatremia, and acute glucocorticoid deficiency. These complications often lead to residual neurological deficits, severely affecting patients' quality of life. The most common cause of SAH is intracranial aneurysm rupture, specifically an aneurysmal subarachnoid hemorrhage (aSAH). As early as 1963[1], a neuropathological study demonstrated that 68% of patients who passed away soon after an intracranial aneurysm ruptured had extensive hypothalamic lesions. Several clinical studies that followed showed that a high percentage of patients with SAH who were examined between three months and a few years after the hemorrhage had partial anterior pituitary hypofunction (APH) , ranging from 37.5 to 55%[2]. This implies that the frequency of APH following aSAH has been underestimated. aSAH may result in permanent or transient pituitary insufficiency. Currently, there is a general lack of awareness of APH after aSAH. Its clinical manifestations are often insidious, making it difficult for clinicians to recognize, which frequently leads to missed or misdiagnosed cases. This review explores the pathophysiological mechanisms, epidemiology, diagnosis, and treatment of APH following aSAH, aiming to help clinicians better identify this condition, provide timely hormone replacement therapy, aid patient recovery, and improve quality of life.
Keywords
aneurysmal subarachnoid hemorrhage; anterior pituitary hypofunction; pituitary hormone; hormone replacement
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[3] Chinese Society of Neurology, Chinese Stroke Society, Neurovascular Intervention Group of Chinese Society of Neurology. Chinese Guidelines for Diagnosis and Treatment of Subarachnoid Hemorrhage 2019 [J]. Chinese Journal of Neurology, 2019, 12): 1006-7-8-9-10-11-12-13-14-15-16-17-18-19-20-21.
[4] Alexandraki K I, Grossman A. Management of Hypopituitarism [J]. J Clin Med, 2019, 8(12): 2153.
[5] Paragliola R M, Corsello S M. Secondary adrenal insufficiency: from the physiopathology to the possible role of modified-release hydrocortisone treatment [J]. Minerva Endocrinol, 2018, 43(2): 183-97.
[6] Tanriverdi F, Schneider H J, Aimaretti G, et al. Pituitary dysfunction after traumatic brain injury: a clinical and pathophysiological approach [J]. Endocr Rev, 2015, 36(3): 305-42.
[7] Aimaretti G, Ambrosio M R, Di Somma C, et al. Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study [J]. J Clin Endocrinol Metab, 2005, 90(11): 6085-92.
[8] Robba C, Bacigaluppi S, Bragazzi N, et al. Clinical prevalence and outcome impact of pituitary dysfunction after aneurysmal subarachnoid hemorrhage: a systematic review with meta-analysis [J]. Pituitary, 2016, 19(5): 522-35.
[9] Song X, Cong S, Zhang M, et al. Prevalence of pituitary dysfunction after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis [J]. BMC Neurol, 2023, 23(1): 155.
[10] Karaca Z, Hacioglu A, Kelestimur F. Neuroendocrine changes after aneurysmal subarachnoid haemorrhage [J]. Pituitary, 2019, 22(3): 305-21.
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