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Cardoso F, Azizi H, Kilpatrick A, Olayinka O, Khan T, Kahn A, Canale C, Ojimba C, Popoola O, Nuthalapati D, Ahmad M, Iskander M, Chohan A, Parisi S, Umesi U, Kalbouneh H, Bhattacharya A, Kodjo K, Jegede O, Jolayemi A. Chronic Atypical Depression as an Early Feature of Pituitary Adenoma: A Case Report and Literature Review. Case Rep Psychiatry 2019; 2019:4892183. [PMID: 31428501 PMCID: PMC6679844 DOI: 10.1155/2019/4892183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/07/2019] [Accepted: 07/10/2019] [Indexed: 12/11/2022] Open
Abstract
Pituitary adenomas are often diagnosed as incidental findings on brain imaging. We present the case of a 52-year-old African American female patient with long standing depressed mood prior to the incidental finding of a pituitary adenoma. We explore the possibility of certain mood symptoms prompting an early diagnosis of pituitary adenoma.
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Affiliation(s)
- Filipa Cardoso
- St. Matthew's University School of Medicine, Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Heela Azizi
- American University of Antigua College of Medicine, Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Alexander Kilpatrick
- American University of Antigua College of Medicine, Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Olaniyi Olayinka
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Tasmia Khan
- Medical University of the Americas, Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Alexa Kahn
- American University of Antigua College of Medicine, Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Cecilia Canale
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Chiedozie Ojimba
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Olusegun Popoola
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Deepa Nuthalapati
- American University of Antigua College of Medicine, Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Maleeha Ahmad
- American University of Antigua College of Medicine, Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Mirna Iskander
- American University of Antigua College of Medicine, Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Ali Chohan
- American University of Antigua College of Medicine, Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Sara Parisi
- American University of Antigua College of Medicine, Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Ulunma Umesi
- Medical University of the Americas, Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Hashem Kalbouneh
- Saba University School of Medicine, Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Arka Bhattacharya
- American University of Antigua College of Medicine, Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Kodjovi Kodjo
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Oluwole Jegede
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Ayodeji Jolayemi
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
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Shibata A, Matano F, Fujiki Y, Mizunari T, Murai Y, Yokota H, Morita A. Efficacy of Thyrotropin-Releasing Hormone Analog for Protracted Disturbance of Consciousness due to Aneurysmal Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2019; 28:988-993. [PMID: 30660483 DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 12/07/2018] [Accepted: 12/16/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The efficacy of thyrotropin-releasing hormone tartrate (TRH-T) for treating prolonged disturbance of consciousness due to aneurysmal subarachnoid hemorrhage (SAH) remains unclear. The purpose of the present study was to determine whether TRH-T was really effective, and what was the recovery factor when it was valid. This was a retrospective study of a single facility. METHODS We treated 208 patients with aneurysmal SAH at our hospital between 2011 and 2017. Among them, we investigated 97 cases in which TRH-T was administered to prolonged disturbance of consciousness. Thirty one patients with Hasegawa dementia rating scale-revised (HDS-R) score less than 20 were included. Patients' HDS-R scores were evaluated 7 days after clipping the aneurysm and 2 days after completing a course of TRH-T treatment. HDS-R score increases of greater than or over equal to 8 and less than 8 were defined as good and poor outcomes, respectively. Outcomes were compared to 11 patients who did not receive TRH-T treatment. RESULTS Average initial and post-treatment HDS-R scores were 9 ± 6.6 and 19 ± 9.5, respectively. The good outcome group included 19 patients. Statistically significant differences in HDS-R score changes were observed between the group with initial HDS-R scores of 0-4 and the other groups. Poor outcomes were significantly correlated with age of greater than 60 years and initial HDS-R scores less than oroverequal to 4 points. The improvement in HDS-R score was significantly greater in the TRH-T administration group than the control group. CONCLUSIONS TRH-T was effective for treating prolonged disturbance of consciousness due to aneurysmal SAH, especially in young patients with HDS-R scores between 5 and 20.
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Affiliation(s)
- Ami Shibata
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan; Department of Neurosurgery, Chiba Hokusoh Hospital, Inzai, Chiba, Japan.
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Yu Fujiki
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Takayuki Mizunari
- Department of Neurosurgery, Chiba Hokusoh Hospital, Inzai, Chiba, Japan
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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Leonhardt M, Kopczak A, Schäpers B, Limbrock J, Sämann PG, Czisch M, von Steinbuechel N, Jordan M, Schneider HJ, Schneider M, Sievers C, Stalla GK. Low Prevalence of Isolated Growth Hormone Deficiency in Patients After Brain Injury: Results From a Phase II Pilot Study. Front Endocrinol (Lausanne) 2018; 9:723. [PMID: 30619080 PMCID: PMC6305071 DOI: 10.3389/fendo.2018.00723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 11/15/2018] [Indexed: 12/26/2022] Open
Abstract
Growth hormone deficiency (GHD) results in an impaired health-related quality of life (HrQoL) and cognitive impairment in the attention and memory domain. GHD is assumed to be a frequent finding after brain injury due to traumatic brain injury (TBI), aneurysmal subarachnoid hemorrhage (SAH) or ischemic stroke. Hence, we set out to investigate the effects of growth hormone (GH) replacement therapy in patients with isolated GHD after brain injury on HrQoL, cognition, and abdominal fat composition. In total, 1,408 patients with TBI, SAH or ischemic stroke were screened for inclusion. Of those, 54 patients (age 18-65 years) were eligible, and 51 could be tested for GHD with GHRH-L-arginine. In 6 patients (12%), GHD was detected. All patients with isolated GHD (n = 4 [8%], male, mean age ± SD: 49.0 ± 9.8 years) received GH replacement therapy for 6 months at a daily dose of 0.2-0.5 mg recombinant GH depending on age. Results were compared with an untreated control group of patients without hormonal insufficiencies after brain injury (n = 6, male, mean age ± SD: 49.5 ± 13.6 years). HrQoL as well as mood and sleep quality assessed by self-rating questionnaires (Beck Depression Index, Pittsburgh Sleep Quality Index) did not differ between baseline and 6 months within each group or between the two groups. Similarly, cognitive performance as assessed by standardized memory and attention tests did not show significant differences within or between groups. Body mass index was higher in the control vs. the GH replacement group at baseline (p = 0.038), yet not different at 6 months and within groups. Visceral-fat-by-total-fat-ratio measurements obtained from magnetic resonance imaging in 2 patients and 5 control subjects exhibited no consistent pattern. In conclusion, this single center study revealed a prevalence of GHD of about 12% (8% with isolated GHD) in brain injury patients which was lower compared with most of the previously reported cohorts. As a consequence, the sample size was insufficient to conclude on a benefit or no benefit of GH replacement in patients with isolated GHD after brain injury. A higher number of patients will be necessary to draw conclusions in future studies. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01397500.
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Affiliation(s)
| | - Anna Kopczak
- Max Planck Institute of Psychiatry, Munich, Germany
| | | | | | | | | | - Nicole von Steinbuechel
- Institute for Medical Psychology and Medical Sociology, University Medicine Göttingen, Göttingen, Germany
| | | | | | | | - Caroline Sievers
- Max Planck Institute of Psychiatry, Munich, Germany
- Institute of General Medicine, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Günter K. Stalla
- Max Planck Institute of Psychiatry, Munich, Germany
- *Correspondence: Günter K. Stalla
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Jaiswal AK, Yadav S, Sahu RN, Mehrotra A, Behari S, Mahapatra AK. An evaluation of neuroendocrine dysfunction following acute aneurysmal subarachnoid hemorrhage: A prospective study. Asian J Neurosurg 2017; 12:34-36. [PMID: 28413529 PMCID: PMC5379800 DOI: 10.4103/1793-5482.146395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim was to investigate the incidence and pattern of neuroendocrine changes in cases of acute aneurysmal subarachnoid hemorrhage (SAH). MATERIALS AND METHODS Endocrine assessment was performed in 100 consecutive cases of acute aneurysmal SAH presenting within 7 days of ictus. The gonadotropic, somatotrophic, thyrotropic, and corticotrophic axes were evaluated for their possible dysfunction. RESULTS A total of 100 cases (38 males, 62 females; age range - 17-76 years; mean age - 43.6 years) of acute SAH were studied. The aneurysms were located in the anterior circulation (n = 95) and posterior circulation (n = 5). The most common hormone deficiency was of growth hormone (n = 67), followed by gonadotrophin (n = 50), corticotrophin (n = 49) and thyrotrophin (n = 35). Hyperprolactinemia was noted in 10 cases. One-pituitary hormone axis deficiency was noted in 26 cases while 67 cases had two or more pituitary hormone axes dysfunction. A total of 93 cases had hormonal dysfunction in one or more pituitary hormone axes, and seven cases had no hormonal dysfunction. CONCLUSIONS Endocrine dysfunction occurs in 93% cases of acute SAH and multiple pituitary hormone axes dysfunction occurs in 67% cases. It is suggested that hormonal evaluation should be considered as part of management of acute SAH.
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Affiliation(s)
- Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Subhash Yadav
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rabi Narayan Sahu
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashok Kumar Mahapatra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Nyberg C, Karlsson T, Hillered L, Stridsberg M, Ronne Engström E. The Early Endocrine Stress Response in Experimental Subarachnoid Hemorrhage. PLoS One 2016; 11:e0151457. [PMID: 27007694 PMCID: PMC4805209 DOI: 10.1371/journal.pone.0151457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/28/2016] [Indexed: 12/12/2022] Open
Abstract
Introduction In patients with severe illness, such as aneurysmal subarachnoid hemorrhage (SAH), a physiologic stress response is triggered. This includes activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system. The aim of this study was to investigate the very early responses of these systems. Methods A porcine animal model of aneurysmal SAH was used. In this model, blood is injected slowly to the basal cisterns above the anterior skull base until the cerebral perfusion pressure is 0 mm Hg. Sampling was done from blood and urine at -10, +15, +75 and +135 minutes from time of induction of SAH. Analyses of adrenocorticotropic hormone (ACTH), cortisol, aldosterone, catecholamines and chromogranin-A were performed. Results Plasma ACTH, serum cortisol and plasma aldosterone increased in the samples following induction of SAH, and started to decline after 75 minutes. Urine cortisol also increased after SAH. Urine catecholamines and their metabolites were found to increase after SAH. Many samples were however below detection level, not allowing for statistical analysis. Plasma chromogranin-A peaked at 15 minutes after SAH, and thereafter decreased. Conclusions The endocrine stress response after aneurysmal SAH was found to start within 15 minutes in the HPA axis with early peak values of ACTH, cortisol and aldosterone. The fact that the concentrations of the HPA axis hormones decreased 135 minutes after SAH may suggest that a similar pattern exists in SAH patients, thus making it difficult to catch these early peak values. There were also indications of early activation of the sympathetic nervous system, but the small number of valid samples made interpretation difficult.
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Affiliation(s)
- Christoffer Nyberg
- Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Torbjörn Karlsson
- Department of Surgical Sciences, Section of Anesthesiology and Intensive care, Uppsala University, Uppsala, Sweden
| | - Lars Hillered
- Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Mats Stridsberg
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Khajeh L, Blijdorp K, Heijenbrok-Kal MH, Sneekes EM, van den Berg-Emons HJG, van der Lely AJ, Dippel DWJ, Neggers SJCMM, Ribbers GM, van Kooten F. Pituitary dysfunction after aneurysmal subarachnoid haemorrhage: course and clinical predictors—the HIPS study. J Neurol Neurosurg Psychiatry 2015; 86:905-10. [PMID: 25378238 PMCID: PMC4516005 DOI: 10.1136/jnnp-2014-307897] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 08/28/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We describe the occurrence and course of anterior pituitary dysfunction (PD) after aneurysmal subarachnoid haemorrhage (SAH), and identify clinical determinants for PD in patients with recent SAH. METHODS We prospectively collected demographic and clinical parameters of consecutive survivors of SAH and measured fasting state endocrine function at baseline, 6 and 14 months. We included dynamic tests for growth-hormone function. We used logistic regression analysis to compare demographic and clinical characteristics of patients with SAH with and without PD. RESULTS 84 patients with a mean age of 55.8 (±11.9) were included. Thirty-three patients (39%) had PD in one or more axes at baseline, 22 (26%) after 6 months and 6 (7%) after 14 months. Gonadotropin deficiency in 29 (34%) patients and growth hormone deficiency (GHD) in 26 (31%) patients were the most common deficiencies. PD persisted until 14 months in 6 (8%) patients: GHD in 5 (6%) patients and gonadotropin deficiency in 4 (5%). Occurrence of a SAH-related complication was associated with PD at baseline (OR 2.6, CI 2.2 to 3.0). Hydrocephalus was an independent predictor of PD 6 months after SAH (OR 3.3 CI 2.7 to 3.8). PD was associated with a lower score on health-related quality of life at baseline (p=0.06), but not at 6 and 14 months. CONCLUSIONS Almost 40% of SAH survivors have PD. In a small but substantial proportion of patients GHD or gonadotropin deficiency persists over time. Hydrocephalus is independently associated with PD 6 months after SAH. TRIAL REGISTRATION NUMBER NTR 2085.
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Affiliation(s)
- L Khajeh
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - K Blijdorp
- Department of Medicine, Section Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M H Heijenbrok-Kal
- Department of Rehabilitation, Erasmus MC University Medical Center and Rijndam Rehabilitation Center Rotterdam, Rotterdam, The Netherlands
| | - E M Sneekes
- Department of Rehabilitation, Erasmus MC University Medical Center and Rijndam Rehabilitation Center Rotterdam, Rotterdam, The Netherlands
| | - H J G van den Berg-Emons
- Department of Rehabilitation, Erasmus MC University Medical Center and Rijndam Rehabilitation Center Rotterdam, Rotterdam, The Netherlands
| | - A J van der Lely
- Department of Medicine, Section Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D W J Dippel
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - S J C M M Neggers
- Department of Medicine, Section Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - G M Ribbers
- Department of Rehabilitation, Erasmus MC University Medical Center and Rijndam Rehabilitation Center Rotterdam, Rotterdam, The Netherlands
| | - F van Kooten
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Abstract
Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation aneurysms, and therefore the results cannot be reliably extrapolated to larger aneurysms, posterior circulation aneurysms, patients presenting with complex aneurysm morphology, and poor neurological grades. The role of hypothermia is not proven to be neuroprotective according to a large randomized controlled trial, Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which recruited patients with good neurological grades. Patients in this trial were subjected to slow cooling and inadequate cooling time and were rewarmed rapidly. This methodology would have reduced the beneficial effects of hypothermia. Adenosine is found to be beneficial for transient induced hypotension in 2 retrospective analyses, without increasing the risk for cardiac and neurological morbidity. The neurological benefit of pharmacological neuroprotection and neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI is an important cause of morbidity and mortality following SAH, and the pathophysiology is likely multifactorial and not yet understood. At present, oral nimodipine has an established role in the management of DCI, along with maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia, although less common than hyponatremia, is a predictor of poor neurological outcome.
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Affiliation(s)
- Stanlies D'Souza
- Department of Neuroanesthesiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA
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Ma J, Yang X, Yin H, Wang Y, Chen H, Liu C, Han G, Gao F. Effect of thyroid hormone replacement therapy on cognition in long-term survivors of aneurysmal subarachnoid hemorrhage. Exp Ther Med 2015; 10:369-373. [PMID: 26170964 DOI: 10.3892/etm.2015.2475] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 04/16/2015] [Indexed: 11/06/2022] Open
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a recently identified risk factor for chronic hypothyroidism. Patients with hypothyroidism often exhibit cognitive dysfunction. The aim of the present study was to determine the effects of thyroid hormone replacement therapy on cognition in aSAH survivors with hypothyroidism. A study population of 135 patients was recruited and subjected to the Montreal Cognitive Assessment (MoCA) and Beck Depression Inventory. Among the study population, 52 patients exhibited cognitive dysfunction. Thyroid hormone levels were measured in these patients using an electrochemiluminescence immunoassay in order to elucidate possible deficits in the thyrotrophic hormonal axes, and hypothyroidism was confirmed in 31 patients. Among these 31 patients, 22 patients consented to be randomized into groups and were administered levothyroxine replacement or a placebo treatment for 3 months. The MoCA and Wechsler Adult Intelligence Scale-Chinese version (WAIS-RC) testing were performed prior to and following the replacement therapy or placebo treatments. All subjects completed the study with no negative side effects. After 8-12 weeks of oral levothyroxine administration, it was observed that the serum concentration of thyroid-stimulating hormone was restored to normal levels. Furthermore, neuropsychological test results improved following the replacement therapy. A significant improvement was observed in the MoCA scores of the replacement group following therapy, with the exception of the score for abstraction. Additionally, significant improvements in the WAIS-RC were observed in the replacement group, with the exceptions of the information comprehension and letter-number sequencing scores. Thus, the present study has demonstrated the partial normalization of cognitive impairments in patients with hypothyroidism following aSAH as a result of appropriate levothyroxine replacement therapy.
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Affiliation(s)
- Jun Ma
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China ; Department of Neurosurgery, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550002, P.R. China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Hao Yin
- Department of Neurosurgery, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550002, P.R. China
| | - Yang Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Hongbin Chen
- Department of Neurosurgery, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550002, P.R. China
| | - Chuangxi Liu
- Department of Neurosurgery, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550002, P.R. China
| | - Guoqiang Han
- Department of Neurosurgery, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550002, P.R. China
| | - Fangyou Gao
- Department of Neurosurgery, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550002, P.R. China
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9
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Kagerbauer SM, Rothoerl RD, Brawanski A. Pituitary dysfunction after aneurysmal subarachnoid hemorrhage. Neurol Res 2013; 29:283-8. [PMID: 17509228 DOI: 10.1179/016164107x165633] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Patients recovering from aneurysmal SAH often complain about weakness, fatigue and impaired cognitive skills. Pituitary dysfunction might be one possible reason for these complaints, as in patients with traumatic brain injury, hypopituitarism is known to be a common complication. There are only a few studies dealing with this problem in SAH patients, but these studies suggest that pituitary disturbances are very frequent after aneurysmal SAH. But anterior pituitary lobe disturbances might not be the only one responsible for some complaints or complications in patients suffering from aneurysmal SAH. Hyponatremia in the early state after SAH could be a hint for posterior pituitary lobe dysfunction.
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Affiliation(s)
- S M Kagerbauer
- University of Regensburg, Department of Neurosurgery, Regensburg, Germany.
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10
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Hirohata T, Saito N, Takano K, Yamada S, Son JH, Yamada SM, Nakaguchi H, Hoya K, Murakami M, Mizutani A, Okinaga H, Matsuno A. Urinary growth hormone level and insulin-like growth factor-1 standard deviation score (IGF-SDS) can discriminate adult patients with severe growth hormone deficiency. Endocr J 2013. [PMID: 23197045 DOI: 10.1507/endocrj.ej12-0196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Adult growth hormone (GH) deficiency (AGHD) in Japan is diagnosed based on peak GH concentrations during GH provocative tests such as GHRP-2 stimulation test. In this study, we aimed to evaluate the ability of serum insulin-like growth factor-1 (sIGF-1) and urinary GH (uGH) at the time of awakening to diagnose AGHD. Fifty-nine patients with pituitary disease (32 men and 27 women; age 20-85 y (57.5 ± 15.5, mean ± SD) underwent GHRP-2 stimulation and sIGF-1 testing. Thirty-six and 23 patients were diagnosed with and without severe AGHD, respectively based on a peak GH response of <9 ng/mL to GHRP-2 stimulation. Serum IGF-1 was evaluated as a standard deviation score (IGF-1 SDS) based on age and sex. We determined whether uGH levels in urine samples from 42 of the 59 patients at awakening were above or below the sensitivity limit. We evaluated IGF-1 SDS and uGH levels in a control group of 15 healthy volunteers. Values for IGF-1 SDS were significantly lower in patients with, than without (-2.07 ± 1.77 vs.-0.03 ± 0.92, mean ± SD; p < 0.001) AGHD whereas the range of IGF-1 SDS substantially overlapped at > -1.4. IGF-1 SDS discriminated AGHD more effectively in patients aged ≤60 years. The χ2 test revealed a statistical relationship between uGH and AGHD (test statistic: 7.0104 ≥ χ2 (1; 0.01) = 6.6349). When IGF-1 SDS is < -1.4 or uGH is below the sensitivity limit, AGHD can be detected with high sensitivity.
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Affiliation(s)
- Toshio Hirohata
- Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara 299-0111, Japan.
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Abstract
Disruption of the hypothalamic-pituitary-adrenal axes may occur after aneurysmal subarachnoid hemorrhage, resulting in hypopituitarism. An electronic literature search was conducted to identify articles with English-language abstracts published between 1980 and March 2011, which addressed hypothalamic-pituitary-adrenal axis insufficiency and hormone replacement. A total of 18 observational and prospective, randomized studies were selected for this review. Limited data are available, evaluating pituitary effects during the acute stage after subarachnoid hemorrhage, with inconsistent results being reported. Overall, after acute subarachnoid hemorrhage, cortisol levels may initially be supranormal, decreasing toward normal levels over time. During the months to years after subarachnoid hemorrhage, pituitary deficiency may occur in one out of three patients. Limited data suggest modest outcome benefits with fludrocortisone and no benefit or harm from corticosteroids.
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Affiliation(s)
- Paul Vespa
- Division of Neurosurgery, David Geffen School of Medicine at UCLA, University of California, Room 6236A Ronald Reagan UCLA Medical Center, 750 Westwood Blvd, Los Angeles, CA 90095, USA.
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12
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Abstract
Disruption of the hypothalamic-pituitary-adrenal axis may occur after aneurysmal subarachnoid hemorrhage, resulting in hypopituitarism. An electronic literature search was conducted to identify articles with English-language abstracts published between 1980 and March 2011 that addressed hypothalamic-pituitary-adrenal axis insufficiency and hormone replacement. A total of 18 observational and prospective, randomized studies were selected for this review. Limited data are available evaluating pituitary effects during the acute stage after subarachnoid hemorrhage, with inconsistent results reported. Overall, acutely after subarachnoid hemorrhage, cortisol levels may initially be supranormal, decreasing toward normal levels over time. During the months to years after subarachnoid hemorrhage, pituitary deficiency may occur in up to one in three patients. Limited data suggest modest outcome benefits with fludrocortisone and no benefit or harm from corticosteroids.
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Affiliation(s)
- P Vespa
- Department of Neurosurgery, University of California at Los Angeles, Los Angeles, CA, USA.
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Wachter D, Gondermann N, Oertel MF, Nestler U, Rohde V, Böker DK. Pituitary insufficiency after operation of supratentorial intra- and extraaxial tumors outside of the sellar-parasellar region? Neurosurg Rev 2011; 34:509-16. [PMID: 21674148 PMCID: PMC3171671 DOI: 10.1007/s10143-011-0326-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 04/09/2011] [Accepted: 04/23/2011] [Indexed: 01/28/2023]
Abstract
Recent studies investigating pituitary function after non-sellar brain tumor surgery showed that up to 38.2% of patients have pituitary insufficiency (PI). It has been assumed that the operation causes the PI, but preoperative hormone testing, which would have been necessary to prove this assumption, was not performed. The objective of this study is to answer the question if indeed microsurgery is the culprit of PI in patients with operatively treated non-sellar brain tumors. In this prospective trial, 54 patients with supratentorial non-sellar tumors were included. The basal levels of cortisol, prolactin, testosterone, estrogen, IGF-1, fT3, fT4, STH, TSH, ACTH, FSH, and LH were recorded preoperatively on days 1 and 7 after surgery. If basal hormone screening revealed an abnormality, a releasing hormone assay was performed. Before surgery, 24 of the 54 patients (44.4%) already had PI. Additional 25 patients showed either hypocortisolism or hypothyreoidism. As those patients had been pre-treated with dexamethasone and L-thyroxine, these findings were considered not to represent PI but drug effects. Hormone testing on days 1 and 7 after surgery revealed no changes. With 44.4% PI is a frequent finding in brain tumor patients already before surgery. The factors causing preoperative PI remain yet to be identified. The endocrine results after surgery are unchanged which rules out that surgery is the cause of PI.
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Affiliation(s)
- Dorothee Wachter
- Department of Neurosurgery, University Clinics of Giessen and Marburg GmbH, Campus Giessen, Klinikstrasse 29, 35392, Giessen, Germany.
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Parenti G, Cecchi PC, Ragghianti B, Schwarz A, Ammannati F, Mennonna P, Di Rita A, Gallina P, Di Lorenzo N, Innocenti P, Forti G, Peri A. Evaluation of the anterior pituitary function in the acute phase after spontaneous subarachnoid hemorrhage. J Endocrinol Invest 2011; 34:361-5. [PMID: 20811167 DOI: 10.1007/bf03347460] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) is a potential cause of hypopituitarism. Most of the studies regarding the relationship between SAH and anterior pituitary function were retrospective and hormonal assessment was performed several months after SAH. AIM To prospectively evaluate the prevalence of anterior pituitary hormone deficiencies in the acute phase after spontaneous SAH and their possible correlation with clinical and radiological parameters. METHODS Pituitary function was tested in 60 patients within 72 h after spontaneous SAH. RESULTS 56.9% of the patients showed at least one anterior pituitary hormone deficiency: gonadotropin and GH secretion failure represented the most prevalent hormonal deficiencies (33.3 and 22.0%, respectively), whereas ACTH and TSH deficiency was less frequent (7.1 and 1.8%, respectively). With the exception of secondary hypogonadism, the prevalence of other pituitary hormone deficiencies is in agreement with previous studies, which evaluated pituitary function on longterm follow up after SAH. No correlation was found between hypopituitarism and clinical status, as assessed with Hunt-Hess and Glascow Coma Scales. Moreover, no correlation was found between hypopituitarism and bleeding severity evaluated with Fisher's scale. CONCLUSIONS We demonstrated a high prevalence of anterior pituitary hormone deficiencies acutely after SAH. Although part of GH and gonadotropin deficiencies might be a consequence of functional alteration due to SAH itself, the finding of low cortisol levels in this stressful condition strongly suggests the presence of true hypocortisolism. Therefore, an evaluation of pituitary function shortly after SAH might be useful to identify a subset of patients who deserve a more accurate follow-up.
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Affiliation(s)
- G Parenti
- Endocrine Unit, Department of Clinical Physiopathology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
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Bendel S, Koivisto T, Ruokonen E, Rinne J, Romppanen J, Vauhkonen I, Kiviniemi V, Uusaro A. Pituitary-adrenal function in patients with acute subarachnoid haemorrhage: a prospective cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:R126. [PMID: 18851750 PMCID: PMC2592763 DOI: 10.1186/cc7084] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 08/30/2008] [Accepted: 10/13/2008] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Subarachnoid haemorrhage (SAH) may damage the hypothalamo-pituitary-adrenal gland (HPA) axis and disturb cortisol metabolism. There are no available data that relates to the response of the HPA axis in the acute phase of SAH. We aimed to characterise the behavior of serum adrenocorticotropic hormone (ACTH), total cortisol, stimulated total cortisol and free cortisol concentrations in acute aneurysmal SAH. METHODS A prospective cohort study was conducted of patients with acute aneurysmal SAH (n = 30) admitted to a tertiary university hospital. Patients admitted for elective aneurysmal surgery (n = 16) served as the control group. An ACTH stimulation test was performed twice during the first week and at three months. The main outcome measure was description of the ACTH-cortisol response by calculating serum free cortisol and measuring total cortisol and ACTH concentrations. A mixed models method was used for testing between the groups, allowing heterogeneity between the groups. RESULTS Patients with SAH had higher initial serum total cortisol (mean +/- SD; 793 +/- 312 nmol/L) and free cortisol concentrations (83 +/- 55 nmol/L) than control patients (535 +/- 193 nmol/L, p = 0.001 and 33 +/- 18 nmol/L, p < 0.001, respectively). Thereafter, there were no differences in this respect. Serum free and total cortisol concentrations correlated but were unaffected by the severity of SAH. ACTH concentrations were comparable between SAH and control groups. Patients with Hunt-Hess grades IV to V had higher ACTH concentrations at day one (10.7 +/- 7.1 pmol/l/L) and day five (8.2 +/- 7.7 pmol/L) than patients with grade I-III (day one: 3.8 +/- 2.0 pmol/L, p = 0.002; day five: 4.7 +/- 1.8 pmol/L, p = 0.04). CONCLUSIONS Calculation of serum free cortisol concentration was not helpful in identifying patients with potential hypocortisolism. SAH severity did not affect cortisol concentrations, possibly indicating relative pituitary-adrenal insufficiency in patients with more severe bleeding. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT00614887.
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Affiliation(s)
- Stepani Bendel
- Department of Intensive Care, Kuopio University Hospital and Kuopio University, Puijonlaaksontie 2, 70211 Kuopio, Finland.
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Aragón Valera C, Antón Bravo T, Varela Da Costa C. Effects of traumatic brain injury and subarachnoid hemorrhage on anterior pituitary function. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2008; 55:170-174. [PMID: 22975453 DOI: 10.1016/s1575-0922(08)70658-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2007] [Accepted: 12/19/2007] [Indexed: 06/01/2023]
Abstract
Traumatic brain injuries and subarachnoid hemorrhage are frequent events in Spain. Both are well recognized causes of anterior hypopituitarism, the prevalence ranging from 20 to 80% according to recent series. Consensus is lacking on how to assess pituitary function after the injury, although periodic assessment is clearly needed because hypopituitarism may appear at any time in the first year after the event. Hormone replacement when necessary helps recovery and reduces morbidity and mortality.
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Affiliation(s)
- Carmen Aragón Valera
- Servicio de Endocrinología. Hospital Universitario Ramón y Cajal. Madrid. España.
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Abstract
Aneurysmal subarachnoid hemorrhage (SAH) is analogous to a pathophysiological watershed, disrupting brain integrity and function and precipitating an array of systemic derangements including cardiovascular, respiratory, endocrine, hematological, and immune dysfunction. Extracerebral organ dysfunction is closely linked to the magnitude of the primary neurological insult, suggesting neurogenic, neuroendocrine and neuroimmunomodulatory mechanisms. Systemic organ involvement is associated with increased mortality and neurological impairment, even after adjustment for other outcome predictors such as the severity of the initial neurological injury. This may be a reflection of secondary brain injury precipitated by hypoxemia, circulatory failure, fever, or hyperglycemia, all of which have been linked to adverse clinical outcomes. Interventions to avert or reverse these and other perturbations need to be tested in clinical trials as they represent opportunities to improve survival and neurological recovery in patients with SAH.
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Affiliation(s)
- Robert D Stevens
- Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Schneider HJ, Stalla GK, Buchfelder M. Expert meeting: hypopituitarism after traumatic brain injury and subarachnoid haemorrhage. Acta Neurochir (Wien) 2006; 148:449-56. [PMID: 16421764 DOI: 10.1007/s00701-005-0724-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- H J Schneider
- Department of Endocrinology and Clinical Chemistry, Max Planck Institute for Psychiatry, Munich, Germany
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Abstract
BACKGROUND The pivotal role of inflammation and edema across the spectrum of central nervous system injury has driven extensive investigation into the therapeutic potential of glucocorticoids. OBJECTIVE To review the experimental and clinical data relating to the efficacy and adverse effects of glucocorticoids in conditions encountered in critical neurologic and neurosurgical illness. DATA SOURCE Search of MEDLINE and Cochrane databases, manual review of article bibliographies. DATA SYNTHESIS AND CONCLUSIONS The efficacy of glucocorticoids is well established in ameliorating edema associated with brain tumors and in improving outcome in subsets of patients with bacterial meningitis. Despite frequently encouraging experimental results, clinical trials of glucocorticoids in ischemic stroke, intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, and traumatic brain injury have not shown a definite therapeutic effect. The evidence supporting glucocorticoid therapy for spinal cord injury is controversial; however methylprednisolone continues to be widely employed in this setting.
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Affiliation(s)
- Joao A Gomes
- Neurosciences Critical Care Division, Department of Anesthesia and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Dimopoulou I, Kouyialis AT, Tzanella M, Armaganidis A, Thalassinos N, Sakas DE, Tsagarakis S. High incidence of neuroendocrine dysfunction in long-term survivors of aneurysmal subarachnoid hemorrhage. Stroke 2004; 35:2884-9. [PMID: 15499033 DOI: 10.1161/01.str.0000147716.45571.45] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To investigate the incidence, pattern, and magnitude 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 aneurysmal SAH. SAH severity was graded clinically by the Hunt & Hess scale (median, II) and radiologically by the Fisher classification (median, II). Patients underwent measurement of basal hormone levels and dynamic assessment by the low-dose (1 microg) corticotropin stimulation test. Functional outcome was examined concurrently with endocrine testing by the modified Rankin Scale and the Barthel Index. RESULTS Of the 30 patients tested, 14 patients (47%) showed isolated or combined endocrine 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 observed in 7% of patients. Median modified Rankin Scale and Barthel Index at the time of endocrine testing were 1 and 100, respectively. There was no correlation between the presence of endocrine dysfunction and SAH severity indices or functional outcome scores. CONCLUSIONS Long-term survivors of aneurysmal SAH frequently exhibit endocrine changes, with growth hormone and gonadal deficiencies predominating. Thus, screening of pituitary function is recommended in patients surviving SAH. The relationship between late hormonal alterations and functional outcome in patients with SAH warrants further study.
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Affiliation(s)
- Ioanna Dimopoulou
- Department of Critical Care Medicine, Evangelismos Hospital, National & Kapodistrian University of Athens, Medical School, Athens, Greece.
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