Download PDF
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2015; 34(03): 179-184
DOI: 10.1055/s-0035-1560032
Original Article | Artigo Original
Thieme Publicações Ltda Rio de Janeiro, Brazil

Alterações endocrinológicas após hemorragia subaracnóidea

Endocrinological Changes after Subarachnoid Hemorrhage
Marcelo Paglioli Ferreira
1   Mestrado em Cirurgia, Research Fellow, Wayne State University, Detroit, MI, United States of America.
,
Carlos Fernando dos Santos Moreira
2   Médico Neurocirurgião, Professor da Faculdade de Medicina da UNESC, Criciúma, SC, Brasil
,
Paulo Valdeci Worm
3   Mestre e Doutor em Cirurgia pela UFRGS, Departamento de Neurocirurgia, Hospital São José - Santa Casa de Porto Alegre, RS, Brasil
› Author Affiliations
Further Information

Publication History

19 November 2014

12 June 2015

Publication Date:
10 August 2015 (online)

   Permissions and Reprints

Resumo

A avaliação da função hipofisária na fase aguda ou tardia dos pacientes que sofrem hemorragia subaracnóidea (HSA) é infrequente; entretanto, a HSA apresenta um risco significante de disfunção pituitária, principalmente devido à vulnerabilidade da sua suplência vascular. Há poucos estudos tratando do tema, mas os existentes sugerem que distúrbios hormonais pós-hemorragia subaracnóidea são mais prevalentes do que inicialmente se suspeitava. Não somente a hipófise anterior parece estar envolvida nessas alterações; a hiponatremia no estágio agudo pode ser uma manifestação de disfunção da hipófise posterior. As alterações hormonais após HSA ainda recebem pouca atenção das equipes assistenciais, podendo ser uma das complicações potencialmente graves sendo tratável quando há suspeição pelo diagnóstico clínico e laboratorial.

Abstract

The evaluation of pituitary function in the acute and at late time in the patients with subarachnoid hemorrhage (SAH) is unusual. Meanwhile the SAH present with a high risc of pituitary disfunction primarily by the vulnerability of the vascular feeding vessels. Few studies about this subject suggest that hormonal disturbance are more prevalent that were suspected before. Both the anterior and posterior pituitary are involved. The hormonal changes after SAH are not well recognized by the physicians and can be treated even been a critical medical situation with clinical and laboratorial findings.

Palavras-Chave

aneurisma cerebral - hemorragia subaracnóidea - hipopituitarismo - deficiência do hormônio de crescimento - hipogonadismo - hipocortisolismo - diabete insípido

Keywords

brain aneurism - subarachnoid hemorrhage - hypopituitarism - hormone replacement therapy - hypogonadism - hypopituitarism - diabetes insipidus
 

  • Referências

  • 1 Erfurth EM, Hagmar L. Cerebrovascular disease in patients with pituitary tumors. Trends Endocrinol Metab 2005; 16 (7) 334-342
    CrossrefPubMedGoogle Scholar
  • 2 Gola M, Bonadonna S, Doga M, Giustina A. Clinical review: Growth hormone and cardiovascular risk factors. J Clin Endocrinol Metab 2005; 90 (3) 1864-1870
    CrossrefPubMedGoogle Scholar
  • 3 Vance ML. Hypopituitarism. N Engl J Med 1994; 330 (23) 1651-1662
    CrossrefPubMedGoogle Scholar
  • 4 Rosén T, Bengtsson BA. Premature mortality due to cardiovascular disease in hypopituitarism. Lancet 1990; 336 (8710) 285-288
    CrossrefPubMedGoogle Scholar
  • 5 Tomlinson JW, Holden N, Hills RK , et al; West Midlands Prospective Hypopituitary Study Group. Association between premature mortality and hypopituitarism. Lancet 2001; 357 (9254) 425-431
    CrossrefPubMedGoogle Scholar
  • 6 Nieuwkamp DJ, Vaartjes I, Algra A, Rinkel GJ, Bots ML. Risk of cardiovascular events and death in the life after aneurysmal subarachnoid haemorrhage: a nationwide study. Int J Stroke 2014; 9 (8) 1090-1096
    CrossrefPubMedGoogle Scholar
  • 7 Powell J, Kitchen N, Heslin J, Greenwood R. Psychosocial outcomes at three and nine months after good neurological recovery from aneurysmal subarachnoid haemorrhage: predictors and prognosis. J Neurol Neurosurg Psychiatry 2002; 72 (6) 772-781
    CrossrefPubMedGoogle Scholar
  • 8 Rinkel GJ, Algra A. Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage. Lancet Neurol 2011; 10 (4) 349-356
    CrossrefPubMedGoogle Scholar
  • 9 Hütter BO, Gilsbach JM, Kreitschmann I. Quality of life and cognitive deficits after subarachnoid haemorrhage. Br J Neurosurg 1995; 9 (4) 465-475
    CrossrefPubMedGoogle Scholar
  • 10 Kreitschmann-Andermahr I. Subarachnoid hemorrhage as a cause of hypopituitarism. Pituitary 2005; 8 (3-4) 219-225
    CrossrefPubMedGoogle Scholar
  • 11 Kreitschmann-Andermahr I, Poll EM, Reineke A , et al. Diagnosing neuroendocrine dysfunction in patients after aneurysmal subarachnoid hemorrhage in clinical practice - does basal hormone screening make sense?. Exp Clin Endocrinol Diabetes 2008; 116 (5) 276-281
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Giordano G, Aimaretti G, Ghigo E. Variations of pituitary function over time after brain injuries: the lesson from a prospective study. Pituitary 2005; 8 (3-4) 227-231
    CrossrefPubMedGoogle Scholar
  • 13 Casulari LA, Mangieri P, Naves LA, Suzuki K, Ferreira M, Domingues L. Nonthyroidal illness syndrome in patients with subarachnoid hemorrhage due to intracranial aneurysm. Arq Neuropsiquiatr 2004; 62 (1) 26-32
    CrossrefPubMedGoogle Scholar
  • 14 Jovanovic V, Pekic S, Stojanovic M , et al. Neuroendocrine dysfunction in patients recovering from subarachnoid hemorrhage. Hormones (Athens) 2010; 9 (3) 235-244
    CrossrefPubMedGoogle Scholar
  • 15 Klose M, Brennum J, Poulsgaard L, Kosteljanetz M, Wagner A, Feldt-Rasmussen U. Hypopituitarism is uncommon after aneurysmal subarachnoid haemorrhage. Clin Endocrinol (Oxf) 2010; 73 (1) 95-101 Epub ahead of print
    PubMedGoogle Scholar
  • 16 Klose M, Juul A, Poulsgaard L, Kosteljanetz M, Brennum J, Feldt-Rasmussen U. Prevalence and predictive factors of post-traumatic hypopituitarism. Clin Endocrinol (Oxf) 2007; 67 (2) 193-201
    CrossrefPubMedGoogle Scholar
  • 17 Parenti G, Cecchi PC, Ragghianti B , et al. Evaluation of the anterior pituitary function in the acute phase after spontaneous subarachnoid hemorrhage. J Endocrinol Invest 2011; 34 (5) 361-365
    CrossrefPubMedGoogle Scholar
  • 18 Schneider HJ, Schneider M, Kreitschmann-Andermahr I , et al. Structured assessment of hypopituitarism after traumatic brain injury and aneurysmal subarachnoid hemorrhage in 1242 patients: the German interdisciplinary database. J Neurotrauma 2011; 28 (9) 1693-1698
    CrossrefPubMedGoogle Scholar
  • 19 Tanriverdi F, Dagli AT, Karaca Z , et al. High risk of pituitary dysfunction due to aneurysmal subarachnoid haemorrhage: a prospective investigation of anterior pituitary function in the acute phase and 12 months after the event. Clin Endocrinol (Oxf) 2007; 67 (6) 931-937
    CrossrefPubMedGoogle Scholar
  • 20 Tanriverdi F, Unluhizarci K, Coksevim B, Selcuklu A, Casanueva FF, Kelestimur F. Kickboxing sport as a new cause of traumatic brain injury-mediated hypopituitarism. Clin Endocrinol (Oxf) 2007; 66 (3) 360-366
    CrossrefPubMedGoogle Scholar
  • 21 Aimaretti G, Ambrosio MR, Di Somma C , et al. Traumatic brain injury and subarachnoid haemorrhage are conditions at high risk for hypopituitarism: screening study at 3 months after the brain injury. Clin Endocrinol (Oxf) 2004; 61 (3) 320-326
    CrossrefPubMedGoogle Scholar
  • 22 Aimaretti G, Ambrosio MR, Di Somma C , et al. Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study. J Clin Endocrinol Metab 2005; 90 (11) 6085-6092
    CrossrefPubMedGoogle Scholar
  • 23 Schneider HJ, Kreitschmann-Andermahr I, Ghigo E, Stalla GK, Agha A. Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review. JAMA 2007; 298 (12) 1429-1438
    CrossrefPubMedGoogle Scholar
  • 24 Crompton MR. Hypothalamic lesions following closed head injury. Brain 1971; 94 (1) 165-172
    CrossrefPubMedGoogle Scholar
  • 25 Tanriverdi F, De Bellis A, Bizzarro A , et al. Antipituitary antibodies after traumatic brain injury: is head trauma-induced pituitary dysfunction associated with autoimmunity?. Eur J Endocrinol 2008; 159 (1) 7-13
    CrossrefPubMedGoogle Scholar
  • 26 Kreitschmann-Andermahr I, Hartmann Y, Poll E, Schneider HJ, Buchfelder M, Stalla GK. The German database on hypopituitarism after traumatic brain injury and aneurysmal subarachnoid hemorrhage - description, objectives and design. Exp Clin Endocrinol Diabetes 2011; 119 (1) 15-20
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Chyatte D, Porterfield R. Functional outcome after repair of unruptured intracranial aneurysms. J Neurosurg 2001; 94 (3) 417-421
    CrossrefPubMedGoogle Scholar
  • 28 Kreitschmann-Andermahr I, Hoff C, Niggemeier S , et al. Pituitary deficiency following aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 2003; 74 (8) 1133-1135
    CrossrefPubMedGoogle Scholar
  • 29 Kreitschmann-Andermahr I, Hoff C, Saller B , et al. Prevalence of pituitary deficiency in patients after aneurysmal subarachnoid hemorrhage. J Clin Endocrinol Metab 2004; 89 (10) 4986-4992
    CrossrefPubMedGoogle Scholar
  • 30 Agha A, Thompson CJ. High risk of hypogonadism after traumatic brain injury: clinical implications. Pituitary 2005; 8 (3-4) 245-249
    CrossrefPubMedGoogle Scholar
  • 31 Agha A, Rogers B, Mylotte D , et al. Neuroendocrine dysfunction in the acute phase of traumatic brain injury. Clin Endocrinol (Oxf) 2004; 60 (5) 584-591
    CrossrefPubMedGoogle Scholar
  • 32 Agha A, Rogers B, Sherlock M , et al. Anterior pituitary dysfunction in survivors of traumatic brain injury. J Clin Endocrinol Metab 2004; 89 (10) 4929-4936
    CrossrefPubMedGoogle Scholar
  • 33 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 (5) 743-752
    CrossrefPubMedGoogle Scholar
  • 34 Schneider HJ, Schneider M, Saller B , et al. Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury. Eur J Endocrinol 2006; 154 (2) 259-265
    CrossrefPubMedGoogle Scholar
  • 35 Byrne JV. The aneurysm “clip or coil” debate. Acta Neurochir (Wien) 2006; 148 (2) 115-120
    CrossrefPubMedGoogle Scholar
  • 36 Niskanen M, Koivisto T, Ronkainen A, Rinne J, Ruokonen E. Resource use after subarachnoid hemorrhage: comparison between endovascular and surgical treatment. Neurosurgery 2004; 54 (5) 1081-1086 , discussion 1086–1088
    CrossrefPubMedGoogle Scholar
  • 37 Brilstra EH, Rinkel GJ, van der Graaf Y , et al. Quality of life after treatment of unruptured intracranial aneurysms by neurosurgical clipping or by embolisation with coils. A prospective, observational study. Cerebrovasc Dis 2004; 17 (1) 44-52
    CrossrefPubMedGoogle Scholar
  • 38 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 (4) 302-306
    PubMedGoogle Scholar
  • 39 Khanna RK, Malik GM, Qureshi N. Predicting outcome following surgical treatment of unruptured intracranial aneurysms: a proposed grading system. J Neurosurg 1996; 84 (1) 49-54
    CrossrefPubMedGoogle Scholar
  • 40 Lamberts SW, de Herder WW, van der Lely AJ. Pituitary insufficiency. Lancet 1998; 352 (9122) 127-134
    CrossrefPubMedGoogle Scholar
  • 41 Levy A. Pituitary disease: presentation, diagnosis, and management. J Neurol Neurosurg Psychiatry 2004; 75 (Suppl. 03) iii47-iii52
    PubMedGoogle Scholar
  • 42 van Aken MO, Lamberts SWJ. Diagnosis and treatment of hypopituitarism: an update. Pituitary 2005; 8 (3-4) 183-191
    CrossrefPubMedGoogle Scholar
  • 43 Sherlock M, O'Sullivan E, Agha A , et al. The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage. Clin Endocrinol (Oxf) 2006; 64 (3) 250-254
    CrossrefPubMedGoogle Scholar
  • 44 Arlt W, Allolio B. Adrenal insufficiency. Lancet 2003; 361 (9372) 1881-1893
    CrossrefPubMedGoogle Scholar
  • 45 Karaca Z, Lale A, Tanriverdi F, Kula M, Unluhizarci K, Kelestimur F. The comparison of low and standard dose ACTH and glucagon stimulation tests in the evaluation of hypothalamo-pituitary-adrenal axis in healthy adults. Pituitary 2011; 14 (2) 134-140
    CrossrefPubMedGoogle Scholar
  • 46 Shin IY, Joo HM, Chung YG, Kim MS, Park JW, Ahn RS. Abnormal diurnal pattern of cortisol secretion in patients after aneurysmal subarachnoid hemorrhage. Stress 2011; 14 (2) 156-165
    CrossrefPubMedGoogle Scholar
  • 47 Freda PU, Post KD, Powell JS, Wardlaw SL. Evaluation of disease status with sensitive measures of growth hormone secretion in 60 postoperative patients with acromegaly. J Clin Endocrinol Metab 1998; 83 (11) 3808-3816
    CrossrefPubMedGoogle Scholar
  • 48 Popovic V, Leal A, Micic D , et al. GH-releasing hormone and GH-releasing peptide-6 for diagnostic testing in GH-deficient adults. Lancet 2000; 356 (9236) 1137-1142
    CrossrefPubMedGoogle Scholar
  • 49 Mehta A, Hindmarsh PC, Stanhope RG, Brain CE, Preece MA, Dattani MT. Is the thyrotropin-releasing hormone test necessary in the diagnosis of central hypothyroidism in children. J Clin Endocrinol Metab 2003; 88 (12) 5696-5703
    CrossrefPubMedGoogle Scholar
  • 50 Aimaretti G, Baffoni C, Ambrosio MR , et al. DHEA-S levels in hypopituitaric patients with severe GH deficiency are strongly reduced across lifespan. Comparison with IGF-I levels before and during rhGH replacement. J Endocrinol Invest 2000; 23 (1) 5-11
    CrossrefPubMedGoogle Scholar
  • 51 Nasrallah MP, Arafah BM. The value of dehydroepiandrosterone sulfate measurements in the assessment of adrenal function. J Clin Endocrinol Metab 2003; 88 (11) 5293-5298
    CrossrefPubMedGoogle Scholar
  • 52 Bengtsson BA, Edén S, Lönn L , et al. Treatment of adults with growth hormone (GH) deficiency with recombinant human GH. J Clin Endocrinol Metab 1993; 76 (2) 309-317
    CrossrefPubMedGoogle Scholar
  • 53 Vernet M, Rapenne T, Beaurain J, Verges B, Combes JC, Freysz M. Hypopituitarism after surgical clipping of a ruptured cerebral aneurysm. Crit Care Med 2001; 29 (11) 2220-2222
    CrossrefPubMedGoogle Scholar
  • 54 Esteban NV, Loughlin T, Yergey AL , et al. Daily cortisol production rate in man determined by stable isotope dilution/mass spectrometry. J Clin Endocrinol Metab 1991; 72 (1) 39-45
    CrossrefPubMedGoogle Scholar
  • 55 Agha A, Liew A, Finucane F , et al. Conventional glucocorticoid replacement overtreats adult hypopituitary patients with partial ACTH deficiency. Clin Endocrinol (Oxf) 2004; 60 (6) 688-693
    CrossrefPubMedGoogle Scholar
  • 56 Callies F, Fassnacht M, van Vlijmen JC , et al. Dehydroepiandrosterone replacement in women with adrenal insufficiency: effects on body composition, serum leptin, bone turnover, and exercise capacity. J Clin Endocrinol Metab 2001; 86 (5) 1968-1972
    CrossrefPubMedGoogle Scholar
  • 57 Hunt PJ, Gurnell EM, Huppert FA , et al. Improvement in mood and fatigue after dehydroepiandrosterone replacement in Addison's disease in a randomized, double blind trial. J Clin Endocrinol Metab 2000; 85 (12) 4650-4656
    CrossrefPubMedGoogle Scholar
  • 58 Løvås K, Gebre-Medhin G, Trovik TS , et al. Replacement of dehydroepiandrosterone in adrenal failure: no benefit for subjective health status and sexuality in a 9-month, randomized, parallel group clinical trial. J Clin Endocrinol Metab 2003; 88 (3) 1112-1118
    CrossrefPubMedGoogle Scholar
  • 59 Ferretti E, Persani L, Jaffrain-Rea ML, Giambona S, Tamburrano G, Beck-Peccoz P. Evaluation of the adequacy of levothyroxine replacement therapy in patients with central hypothyroidism. J Clin Endocrinol Metab 1999; 84 (3) 924-929
    PubMedGoogle Scholar
  • 60 Walsh JP, Shiels L, Lim EM , et al. Combined thyroxine/liothyronine treatment does not improve well-being, quality of life, or cognitive function compared to thyroxine alone: a randomized controlled trial in patients with primary hypothyroidism. J Clin Endocrinol Metab 2003; 88 (10) 4543-4550
    CrossrefPubMedGoogle Scholar
  • 61 Roberts CG, Ladenson PW. Hypothyroidism. Lancet 2004; 363 (9411) 793-803
    CrossrefPubMedGoogle Scholar
  • 62 Schneider HJ, Aimaretti G, Kreitschmann-Andermahr I, Stalla GK, Ghigo E. Hypopituitarism. Lancet 2007; 369 (9571) 1461-1470
    CrossrefPubMedGoogle Scholar
  • 63 Monson JP. Biochemical markers of individual response to growth hormone replacement in adults. Horm Res 2001; 55 (Suppl. 02) 49-54
    CrossrefPubMedGoogle Scholar
  • 64 Drake WM, Howell SJ, Monson JP, Shalet SM. Optimizing gh therapy in adults and children. Endocr Rev 2001; 22 (4) 425-450
    CrossrefPubMedGoogle Scholar
  • 65 Attanasio AF, Bates PC, Ho KK , et al; Hypoptiuitary Control and Complications Study International Advisory Board. Human growth hormone replacement in adult hypopituitary patients: long-term effects on body composition and lipid status—3-year results from the HypoCCS Database. J Clin Endocrinol Metab 2002; 87 (4) 1600-1606
    CrossrefPubMedGoogle Scholar
  • 66 Drake WM, Coyte D, Camacho-Hübner C , et al. Optimizing growth hormone replacement therapy by dose titration in hypopituitary adults. J Clin Endocrinol Metab 1998; 83 (11) 3913-3919
    CrossrefPubMedGoogle Scholar
  • 67 Arafah BM. Increased need for thyroxine in women with hypothyroidism during estrogen therapy. N Engl J Med 2001; 344 (23) 1743-1749
    CrossrefPubMedGoogle Scholar
  • 68 Rodríguez-Arnao J, Perry L, Besser GM, Ross RJ. Growth hormone treatment in hypopituitary GH deficient adults reduces circulating cortisol levels during hydrocortisone replacement therapy. Clin Endocrinol (Oxf) 1996; 45 (1) 33-37
    CrossrefPubMedGoogle Scholar