University Department of Obesity and Endocrinology, Aintree University Hospital NHS Foundation Trust, University Hospital Aintree, Liverpool, UK.
Eur J Endocrinol. 2013 Mar 15;168(4):473-81. doi: 10.1530/EJE-12-0849. Print 2013 Apr.
Hypopituitarism following subarachnoid haemorrhage (SAH) has been reported to be a frequent occurrence. However, there is considerable heterogeneity between studies with differing patient populations and treatment modalities and most importantly employing differing endocrine protocols and (normal) reference ranges of GH. We aimed to examine prospectively a cohort of SAH survivors for development of hypopituitarism post-SAH using rigorous endocrine testing and compare GH response to glucagon stimulation with a cohort of healthy controls of a similar BMI.
Sixty-four patients were investigated for evidence of hypopituitarism 3 months post-SAH with 50 patients tested again at 12 months. Glucagon stimulation testing (GST), with confirmation of deficiencies by GHRH/arginine testing for GH deficiency (GHD) and short synacthen testing for ACTH deficiency, was used. Basal testing of other hormonal axes was undertaken.
Mean age of patients was 53±11.7 years and mean BMI was 27.5±5.7 kg/m(2). After confirmatory testing, the prevalence of hypopituitarism was 12% (GHD 10%, asymptomatic hypocortisolaemia 2%). There was no association between hypopituitarism and post-SAH vasospasm, presence of cerebral infarction, Fisher grade, or clinical grading at presentation. There was a significant correlation between BMI and peak GH to glucagon stimulation in both patients and controls.
Identification of 'true' GHD after SAH requires confirmatory testing with an alternative stimulation test and application of BMI-specific cut-offs. Using such stringent criteria, we found a prevalence of hypopituitarism of 12% in our population.
蛛网膜下腔出血（SAH）后发生垂体功能减退症已有报道，较为常见。然而，由于患者人群和治疗方式不同，研究之间存在很大的异质性，最重要的是，采用了不同的内分泌检测方案和（正常）GH 参考范围。我们旨在使用严格的内分泌检测，前瞻性地检查一组 SAH 幸存者在 SAH 后是否发生垂体功能减退症，并将 GH 对胰高血糖素刺激的反应与一组具有相似 BMI 的健康对照者进行比较。
64 例患者在 SAH 后 3 个月接受了垂体功能减退症的证据检查，其中 50 例患者在 12 个月时再次接受检查。使用胰高血糖素刺激试验（GST），通过 GHRH/精氨酸检测 GH 缺乏症（GHD）和短 Synacthen 检测 ACTH 缺乏症来确认缺乏情况，对患者进行了检测。对其他激素轴进行了基础检测。
患者的平均年龄为 53±11.7 岁，平均 BMI 为 27.5±5.7kg/m2。经过确证性检测，垂体功能减退症的患病率为 12%（GHD10%，无症状性皮质醇减少症 2%）。垂体功能减退症与 SAH 后血管痉挛、脑梗死、Fisher 分级或发病时的临床分级之间无相关性。在患者和对照组中，BMI 与胰高血糖素刺激后 GH 的峰值均存在显著相关性。
在 SAH 后确定“真正”的 GHD 需要使用替代刺激试验进行确证性检测，并应用 BMI 特异性截止值。使用如此严格的标准，我们发现我们人群中的垂体功能减退症患病率为 12%。
