Download PDF
CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2023; 42(02): e105-e113
DOI: 10.1055/s-0043-1769782
Original Article | Artigo Original

Pituitary Hormonal Disturbances in Aneurysmal Subarachnoid Hemorrhage

Distúrbios hormonais pituitários na hemorragia subaracnóidea aneurismática
Jose Carlos de Moura 
1   Neurosurgery Department, School of Medicine, Universidade Federal do Vale do São Francisco, Petrolina PE, Brazil
,
Hildo Rocha Cirne de Azevedo 
2   Neurosurgery Department, Federal University of Pernambuco, Recife, PE, Brazil
,
Marcelo Moraes Valença 
3   Neurosurgery Department, University of Pernambuco, Recife, PE, Brazil
,
Claudio Henrique Fernandes Vidal
4   Neurosurgery Department, Federal University of Pernambuco, Recife, Brazil
,
Samuel Miranda de Moura 
6   Neurosurgery Department, Hospital Beneficiência Portuguesa, São Paulo, SP, Brazil
,
Mateus de Sousa Rodrigues 
6   Neurosurgery Department, Hospital Beneficiência Portuguesa, São Paulo, SP, Brazil
8   Neurosurgery Department, Hospital da Restauração, Recife, PE, Brazil
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective The objective of the present study was to assess the hormonal alterations that occurred in patients with subarachnoid hemorrhage.

Methods This is a case series with 21 patients diagnosed with subarachnoid hemorrhage of aneurysmal etiology up to 30 days after the ictus. The following hormonal measurements were performed in these patients: cortisol, GH, testosterone, prolactin, estradiol, FSH, LH, FSH, T3, T4 and free T4. The hormonal results of the cases were compared with the results of twelve volunteers from the control group and correlated with findings in brain tomography, cerebral angiography, Hunt-Hess scale, and vasospasm.

Results The main altered hormones were cortisol (52.6%), GH (42.9%) and TSH (28.6%). There was a trend towards more severe cases in the following groups of patients: Hunt-Hess scale > 2, Fisher scale > 1, aneurysmal topography in the anterior communicating artery and those who had vasospasm.

Conclusion The present study observed the tendency of pituitary hormonal changes in patients with subarachnoid hemorrhage of aneurysmal etiology, corroborating the need for dosage of hormones from the hypothalamic-pituitary axis in the management of these cases.

Resumo

Objetivo O objetivo do presente estudo foi avaliar as alterações hormonais em pacientes com hemorragia subaracnóidea e correlacionar tais alterações com a gravidade da hemorragia.

Métodos Trata-se de uma série de casos com 21 pacientes com diagnóstico de hemorragia subaracnóidea de etiologia aneurismática até 30 dias do ictus. Foram realizadas as seguintes dosagens hormonais nesses pacientes: cortisol, GH, testosterona, prolactina, estradiol, FSH, LH, FSH, T3, T4 e T4 livre. Os resultados hormonais dos casos foram comparados com os resultados de 12 voluntários do grupo controle e correlacionados com achados em tomografia de crânio, estudo angiográfico cerebral, escala de Hunt-Hess e vasoespasmo.

Resultados Os principais hormônios alterados foram o cortisol (52,6%), GH (42,9%) e o TSH (28,6%). Houve uma tendência de casos mais graves nos seguintes grupos de pacientes: escala de Hunt-Hess > 2, escala de Fisher > 1, topografia aneurismática na artéria comunicante anterior e aqueles que cursaram com o vasoespasmo.

Conclusão O presente estudo observou a tendência de alterações hormonais hipofisárias em pacientes com hemorragia subaracnóidea de etiologia aneurismática, corroborando a necessidade de dosagem dos hormônios do eixo hipotálamo-hipofisário no manejo desses casos.

Keywords

pituitary gland - pan-hypopituitarism - subarachnoid hemorrhage - hormone abnormalities - intracranial aneurysm

Palavras-chave

hipófise - pan-hipopituitarismo - hemorragia subaracnóidea - anormalidades hormonais - aneurisma intracraniano


Publication History

Received: 29 October 2022

Accepted: 24 January 2023

Article published online:
28 June 2023

© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Ferreira M, Moreira C, Worm P. Endocrinological Changes after Subarachnoid Hemorrhage. Braz Neurosurg 2015; 34 (03) 179-184
    PubMedGoogle Scholar
  • 2 Khajeh L, Blijdorp K, Neggers SJ, Ribbers GM, Dippel DW, van Kooten F. Hypopituitarism after subarachnoid haemorrhage, do we know enough?. BMC Neurol 2014; 14 (01) 205
    CrossrefPubMedGoogle Scholar
  • 3 Michils A, Balériaux D, Mockel J. Bilateral carotid aneurysms unmasked by severe hypopituitarism. Postgrad Med J 1991; 67 (785): 285-288
    CrossrefPubMedGoogle Scholar
  • 4 Hoff WV, Hornabrook RW, Marks V. Hypopituitarism associated with intracranial aneurysms. Br Med J 1961; 2 (5261): 1190-1194
    CrossrefPubMedGoogle Scholar
  • 5 Maimaitili A, Maimaitili M, Rexidan A. et al. Pituitary hormone level changes and hypxonatremia in aneurysmal subarachnoid hemorrhage. Exp Ther Med 2013; 5 (06) 1657-1662
    CrossrefPubMedGoogle Scholar
  • 6 Kairys N, M. Das J, Garg M. Acute Subarachnoid Hemorrhage. 2022
    Google Scholar
  • 7 Smith SM, Vale WW. The role of the hypothalamic-pituitary-adrenal axis in neuroendocrine responses to stress. Dialogues Clin Neurosci 2006; 8 (04) 383-395
    CrossrefPubMedGoogle Scholar
  • 8 Edwards OM, Clark JD. Post-traumatic hypopituitarism. Six cases and a review of the literature. Medicine (Baltimore) 1986; 65 (05) 281-290
    CrossrefPubMedGoogle Scholar
  • 9 Rass V, Schoenherr E, Ianosi BA. et al. Subarachnoid Hemorrhage is Followed by Pituitary Gland Volume Loss: A Volumetric MRI Observational Study. Neurocrit Care 2020; 32 (02) 492-501
    CrossrefPubMedGoogle Scholar
  • 10 Crompton MR. Hypothalamic lesions following the rupture of cerebral berry aneurysms. Brain 1963; 86 (02) 301-314
    CrossrefPubMedGoogle Scholar
  • 11 Noel GL, Suh HK, Stone JG, Frantz AG. Human prolactin and growth hormone release during surgery and other conditions of stress. J Clin Endocrinol Metab 1972; 35 (06) 840-851
    CrossrefPubMedGoogle Scholar
  • 12 Verbalis JG, Nelson PB, Robinson AG. Reversible panhypopituitarism caused by a suprasellar aneurysm: the contribution of mass effect to pituitary dysfunction. Neurosurgery 1982; 10 (05) 604-611
    CrossrefPubMedGoogle Scholar
  • 13 Jenkins JS, Buckell M, Carter AB, Westlake S. Hypothalamic-pituitary-adrenal function after subarachnoid haemorrhage. BMJ 1969; 4 (5685): 707-709
    CrossrefPubMedGoogle Scholar
  • 14 Kelly DF, Gonzalo IT, Cohan P, Berman N, Swerdloff R, Wang C. Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report. J Neurosurg 2000; 93 (05) 743-752
    CrossrefPubMedGoogle Scholar
  • 15 Fernández-Real JM, Fernández-Castañer M, Villabona C, Sagarra E, Gómez-Sáez JM, Soler J. Giant intrasellar aneurysm presenting with panhypopituitarism and subarachnoid hemorrhage: case report and literature review. Clin Investig 1994; 72 (04) 302-306
    PubMedGoogle Scholar
  • 16 Karaca Z, Hacioglu A, Kelestimur F. Neuroendocrine changes after aneurysmal subarachnoid haemorrhage. Pituitary 2019; 22 (03) 305-321
    CrossrefPubMedGoogle Scholar
  • 17 Duggan M, Browne I, Flynn C. Adrenal failure in the critically ill. Br J Anaesth 1998; 81 (03) 468-470
    CrossrefPubMedGoogle Scholar
  • 18 Landon J, Greenwood FC, Stamp TC, Wynn V. The plasma sugar, free fatty acid, cortisol, and growth hormone response to insulin, and the comparison of this procedure with other tests of pituitary and adrenal function. II. In patients with hypothalamic or pituitary dysfunction or anorexia nervosa. J Clin Invest 1966; 45 (04) 437-449
    CrossrefPubMedGoogle Scholar
  • 19 Herman JP, McKlveen JM, Ghosal S. et al. Regulation of the Hypothalamic-Pituitary-Adrenocortical Stress Response. Em: Comprehensive Physiology. Wiley; 2016: 603-621
    Google Scholar
  • 20 Krieger DT, Krieger HP. Circadian variation of the plasma 17-hydroxycorticosteroids in central nervous system disease. J Clin Endocrinol Metab 1966; 26 (09) 929-940
    CrossrefPubMedGoogle Scholar
  • 21 Son YL, Ubuka T, Tsutsui K. Regulation of stress response on the hypothalamic-pituitary-gonadal axis via gonadotropin-inhibitory hormone. Front Neuroendocrinol 2022; 64: 100953
    CrossrefPubMedGoogle Scholar
  • 22 Marques P, Skorupskaite K, Rozario KS, Anderson RA, George JT. Physiology of GnRH and Gonadotropin Secretion. 2000
    PubMedGoogle Scholar
  • 23 Osterman PO. Hypothalamo-pituitary-adrenal function following subarachnoid hemorrhage. Acta Neurol Scand 1975; 52 (01) 56-62
    CrossrefPubMedGoogle Scholar
  • 24 Currie PJ, Khelemsky R, Rigsbee EM. et al. Ghrelin is an orexigenic peptide and elicits anxiety-like behaviors following administration into discrete regions of the hypothalamus. Behav Brain Res 2012; 226 (01) 96-105
    CrossrefPubMedGoogle Scholar
  • 25 Colon G, Saccon T, Schneider A. et al. The enigmatic role of growth hormone in age-related diseases, cognition, and longevity. Geroscience 2019; 41 (06) 759-774
    CrossrefPubMedGoogle Scholar
  • 26 Anjum A, Anwar H, Sohail MU. et al. The association between serum cortisol, thyroid profile, paraoxonase activity, arylesterase activity and anthropometric parameters of undergraduate students under examination stress. Eur J Inflamm 2021; 19: 205873922110008
    CrossrefPubMedGoogle Scholar
  • 27 Mangieri P, Suzuki K, Ferreira M, Domingues L, Casulari LA. Evaluation of pituitary and thyroid hormones in patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm. Arq Neuropsiquiatr 2003; 61 (01) 14-19
    CrossrefPubMedGoogle Scholar
  • 28 Tsigos C, Kyrou I, Kassi E, Chrousos GP. Stress: Endocrine Physiology and Pathophysiology. 2000
    PubMedGoogle Scholar
  • 29 Peters JR, Foord SM, Dieguez C, Scanlon MF. TSH neuroregulation and alterations in disease states. Clin Endocrinol Metab 1983; 12 (03) 669-694
    CrossrefPubMedGoogle Scholar
  • 30 Gupta V, Lee M. Central hypothyroidism. Indian J Endocrinol Metab 2011; 15 (6, Suppl 2) S99-S106
    CrossrefPubMedGoogle Scholar
  • 31 Cai Z, Li H. An Updated Review: Androgens and Cognitive Impairment in Older Men. Front Endocrinol (Lausanne) 2020; 11: 586909
    CrossrefPubMedGoogle Scholar
  • 32 Conde DM, Verdade RC, Valadares ALR, Mella LFB, Pedro AO, Costa-Paiva L. Menopause and cognitive impairment: A narrative review of current knowledge. World J Psychiatry 2021; 11 (08) 412-428
    CrossrefPubMedGoogle Scholar
  • 33 Qureshi AI, Suri MFK, Sung GY. et al. Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage. Neurosurgery 2002; 50 (04) 749-755 , discussion 755–756
    CrossrefPubMedGoogle Scholar
  • 34 Saramma P, Menon RG, Srivastava A, Sarma PS. Hyponatremia after aneurysmal subarachnoid hemorrhage: Implications and outcomes. J Neurosci Rural Pract 2013; 4 (01) 24-28
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Disney L, Weir B, Grace M, Roberts P. Trends in blood pressure, osmolality and electrolytes after subarachnoid hemorrhage from aneurysms. Can J Neurol Sci 1989; 16 (03) 299-304
    CrossrefPubMedGoogle Scholar
  • 36 Chandy D, Sy R, Aronow WS, Lee WN, Maguire G, Murali R. Hyponatremia and cerebrovascular spasm in aneurysmal subarachnoid hemorrhage. Neurol India 2006; 54 (03) 273-275
    CrossrefPubMedGoogle Scholar
  • 37 Mapa B, Taylor BES, Appelboom G, Bruce EM, Claassen J, Connolly Jr ES. Impact of Hyponatremia on Morbidity, Mortality, and Complications After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review. World Neurosurg 2016; 85: 305-314
    CrossrefPubMedGoogle Scholar
  • 38 Tam CW, Shum HP, Yan WW. Impact of Dysnatremia and Dyskalemia on Prognosis in Patients with Aneurysmal Subarachnoid Hemorrhage: A Retrospective Study. Indian J Crit Care Med 2019; 23 (12) 562-567
    CrossrefPubMedGoogle Scholar
  • 39 Chua MMJ, Enríquez-Marulanda A, Gomez-Paz S. et al. Sodium Variability and Probability of Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2022; 31 (01) 106186
    CrossrefPubMedGoogle Scholar
  • 40 Cohen J, Delaney A, Anstey J. et al. Dysnatremia and 6-Month Functional Outcomes in Critically Ill Patients With Aneurysmal Subarachnoid Hemorrhage: A Prospective Cohort Study. Crit Care Explor 2021; 3 (06) e0445
    CrossrefPubMedGoogle Scholar