Dimopoulou Ioanna, Kouyialis Andreas T, Tzanella Marinella, Armaganidis Apostolos, Thalassinos Nikolaos, Sakas Damianos E, Tsagarakis Stylianos
Department of Critical Care Medicine, Evangelismos Hospital, National & Kapodistrian University of Athens, Medical School, Athens, Greece.
Stroke. 2004 Dec;35(12):2884-9. doi: 10.1161/01.STR.0000147716.45571.45. Epub 2004 Oct 21.
To investigate the incidence, pattern, and magnitude of neuroendocrine changes in long-term survivors of aneurysmal subarachnoid hemorrhage (SAH).
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.
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.
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.
研究动脉瘤性蛛网膜下腔出血（SAH）长期存活者神经内分泌变化的发生率、模式及程度。
30例患者（16例女性），平均年龄50±13岁，于动脉瘤性SAH后12至24个月接受内分泌评估。SAH严重程度根据Hunt & Hess量表进行临床分级（中位数为II级），并根据Fisher分类进行放射学分级（中位数为II级）。患者接受基础激素水平测定及低剂量（1微克）促肾上腺皮质激素刺激试验的动态评估。通过改良Rankin量表和Barthel指数在进行内分泌检测的同时检查功能预后。
在接受检测的30例患者中，14例患者（47%）出现孤立或合并的内分泌异常。其中包括37%的患者胰岛素样生长因子1水平低，提示生长激素缺乏；13%的患者性腺功能减退；10%的患者皮质醇对低剂量促肾上腺皮质激素刺激试验反应低下；7%的患者存在亚临床甲状腺功能减退形式的甲状腺功能障碍。内分泌检测时改良Rankin量表和Barthel指数的中位数分别为1和100。内分泌功能障碍的存在与SAH严重程度指数或功能预后评分之间无相关性。
动脉瘤性SAH的长期存活者常出现内分泌变化，以生长激素和性腺缺乏为主。因此，建议对SAH存活患者进行垂体功能筛查。SAH患者晚期激素改变与功能预后之间的关系值得进一步研究。
