Exp Clin Endocrinol Diabetes 2008; 116(5): 276-281
DOI: 10.1055/s-2007-1004552
Article

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Diagnosing Neuroendocrine Dysfunction in Patients after Aneurysmal Subarachnoid Hemorrhage in Clinical Practice - Does Basal Hormone Screening Make Sense?

I. Kreitschmann-Andermahr 1 , E. M. Poll 1 , A. Reineke 1 , Y. Langejürgen 1 , E. Yagmur 2 , J. M. Gilsbach 1 , B. Saller 3
  • 1Department of Neurosurgery, University Hospital RWTH Aachen, Germany
  • 2Institute for Clinical Chemistry and Pathobiochemistry, University Hospital RWTH Aachen, Germany
  • 3Department of Endocrinology, University Hospital Essen, Germany
Further Information

Publication History

received 06.09.2007 first decision 01.11.2007

accepted 03.12.2007

Publication Date:
25 March 2008 (online)

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Abstract

Recent studies indicate that neuroendocrine dysfunction is a more frequent sequel of aneurysmal subarachnoid hemorrhage (SAH), than has so far been recognized. However, from the available data it remains unclear whether certain subgroups of SAH patients carry a higher risk to sustain endocrine sequelae due to the hemorrhage than others and should be specifically followed-up in terms of hormone assessment. To investigate whether a basal hormone screening is a practical method in clinical routine to single out patients in whom endocrine function testing is warranted, we established a screening protocol, based on the findings from a cohort of 40 SAH patients (study group) who had all been investigated by basal hormone parameters as well as standardized endocrinological function testing, within the framework of a previously published clinical study. We then applied this protocol to 45 newly investigated SAH-patients (screening group). According to the thus established protocol, 20 of the 45 screened patients (44.4%) were recommended further investigations, 12 of whom agreed to undergo dynamic endocrine function testing. Altogether, the percentage of test-confirmed neuroendocrine dysfunction was only 13.3% (6/45) in the screening group as compared to 55% in the study group. Low IGF-I (2 SD below normal) did not serve to predict growth hormone deficiency, whereas low 9 am serum cortisol was of limited value to single out ACTH-deficiency in SAH-patients. In summary we conclude that basal hormone screening is not sufficient to identify SAH patients with impaired hypothalamo-pituitary function, at least not in the context of clinical routine practice.