Department of Endocrinology, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Greater Manchester, M6 8HD, UK.
Department of Endocrinology and Diabetes, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Greater Manchester, M6 8HD, UK.
Pituitary. 2017 Dec;20(6):624-634. doi: 10.1007/s11102-017-0825-7.
The variation in reported prevalence of growth hormone deficiency (GHD) post subarachnoid haemorrhage (SAH) is mainly due to methodological heterogeneity. We report on the prevalence of GHD in a large cohort of patients following SAH, when dynamic and confirmatory pituitary hormone testing methods are systematically employed.
In this cross-sectional study, pituitary function was assessed in 100 patients following SAH. Baseline pituitary hormonal profile measurement and glucagon stimulation testing (GST) was carried out in all patients. Isolated GHD was confirmed with an Arginine stimulation test and ACTH deficiency was confirmed with a short synacthen test.
The prevalence of hypopituitarism in our cohort was 19% and the prevalence of GHD was 14%. There was no association between GHD and the clinical or radiological severity of SAH at presentation, treatment modality, age, or occurrence of vasospasm. There were statistically significant differences in terms of Glasgow Outcome Scale (GOS; p = 0.03) between patients diagnosed with GHD and those without. Significant inverse correlations between GH peak on GST with body mass index (BMI) and waist hip ratio (WHR) was also noted (p < 0.0001 and p < 0.0001 respectively).
Using the current testing protocol, the prevalence of GHD detected in our cohort was 14%. It is unclear if the BMI and WHR difference observed is truly due to GHD or confounded by the endocrine tests used in this protocol. There is possibly an association between the development of GHD and worse GOS score. Routine endocrine screening of all SAH survivors with dynamic tests is time consuming and may subject many patients to unnecessary side-effects. Furthermore the degree of clinical benefit derived from growth hormone replacement in this patient group, remains unclear. Increased understanding of the most appropriate testing methodology in this patient group and more importantly which SAH survivors would derive most benefit from GHD screening is required.
蛛网膜下腔出血（SAH）后报道的生长激素缺乏症（GHD）患病率的差异主要归因于方法学的异质性。我们报告了在使用系统的动态和确证性垂体激素检测方法的情况下，大量 SAH 患者中 GHD 的患病率。
在这项横断面研究中，对 100 例 SAH 后患者的垂体功能进行了评估。所有患者均进行了基线垂体激素谱测量和胰高血糖素刺激试验（GST）。采用精氨酸刺激试验证实孤立性 GHD，采用短 Synacthen 试验证实 ACTH 缺乏。
我们队列中的垂体功能减退症患病率为 19%，GHD 患病率为 14%。GHD 与 SAH 发病时的临床或影像学严重程度、治疗方式、年龄或血管痉挛的发生均无关联。在诊断为 GHD 的患者和未诊断为 GHD 的患者之间，格拉斯哥结局量表（GOS；p=0.03）存在统计学差异。还注意到 GST 时 GH 峰值与体重指数（BMI）和腰臀比（WHR）呈显著负相关（p<0.0001 和 p<0.0001 分别）。
使用当前的检测方案，我们队列中检测到的 GHD 患病率为 14%。尚不清楚观察到的 BMI 和 WHR 差异是否真的是由于 GHD 引起的，还是由于该方案中使用的内分泌测试所致。GHD 的发生与较差的 GOS 评分之间可能存在关联。对所有 SAH 幸存者进行动态测试的常规内分泌筛查既耗时又可能使许多患者遭受不必要的副作用。此外，在该患者群体中，生长激素替代治疗的临床获益程度仍不清楚。需要进一步了解该患者群体中最合适的检测方法，更重要的是，哪些 SAH 幸存者最受益于 GHD 筛查。
