Hypopituitarism in patients after
subarachnoid hemorrhage:
Screening and treatment.

Spontaneous subarachnoidal hemorrhage (SAH) occurs with an incidence of six cases per 100.000 patient years, with a case mortality amounting to 50% (1). In patients who survived SAH, high rates of functional limitations are found along with quality-of-life impairment, such as fatigue, decreased mobility, loss of motivation, reduced independence in activities of daily living and decreased social functioning (1,2).

The residual functional problems in patients after SAH are often unexplained, but may largely resemble those occurring in patients with untreated hypopituitarism. Corticotrophin and TSH deficiency may present with symptoms such as fatigue, weakness, headache, altered mental activity or impaired memory. Symptoms attributable to Growth Hormone deficiency include lack of vigor, decreased exercise tolerance and decreased social functioning with loss of quality of life (2).
Recent studies in long-term survivors of SAH have shown varying incidences (from 20 up to 50%) of hypopituitarism, with growth hormone deficiency (GHD) occurring in 15 - 25% of patients (3,2,4,5). This neuroendocrine dysfunction could be the result of damage to the hypothalamic/pituitary system caused by post hemorrhagic local tissue pressure, toxic effects of the extravasated blood, ischemia caused by vasospasm, high intracranial pressure, hydrocephalus or local destruction during cerebral surgery. At present, it is not possible to identify which SAH patients are at risk of developing hypopituitarism. The clinical effects of optimal hormone replacement therapy on residual symptoms in SAH patients is unknown

The aim of the present study is:

1. To determine the incidence of hypopituitarism in subjects after SAH, using a routine hormonal screening protocol;

2. To identify prognostic neurological determinants for the development of hypopituitarism following SAH;

3. To evaluate the value of the GRPH-6 test in the acute phase of SAH in determinating the presence of growth hormone deficiency.

1. Visit 1: During admission for SAH;

2. Visit 2: Week 12 (3 months after SAH);

3. Visit 3: Week 18 (6 weeks after start hormone suppletion)
(Only for patients with established hormone deficiency);

4. Visit 4: Week 24 (6 months after SAH);

5. Visit 5: Week 28 (4 weeks after start GH-suppletion);

6. Visit 6: Week 44 (20 weeks after start GH-suppletion);

7. Visit 7: Week 60 (36 weeks after start GH-suppletion).

Replacement of hormone defeciencies as required.