Perspectives Commentary on: High Prevalence of Pituitary Dysfunction After Aneurysmal Subarachnoid Hemorrhage: A Long-Term Prospective Study Using Dynamic Endocrine Testing by Kronvall et al. World Neurosurg 83:574-582, 2015

Pituitary Dysfunction After Aneurysmal Subarachnoid Hemorrhage Bradley A. Gross and Edward R. Laws

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ituitary dysfunction affecting at least 1 axis after aneurysmal subarachnoid hemorrhage (aSAH) is common, reported at rates of 37%e55% in contemporary studies (1, 3, 5-7). Despite the frequency of this clinically relevant complication of aSAH, it has been studied in only a few, relatively small studies. A 2007 systematic review of hypothalamopituitary dysfunction after aSAH identified only 3 studies with 102 patients, citing a pooled prevalence of 47% (95% confidence interval ¼ 37%e57%) (7). Although precise rates of pituitary dysfunction after aSAH vary considerably across studies (1, 3, 5-9), they most consistently demonstrate a relative preponderance of growth hormone (GH) deficiency and, less frequently, disturbances of the thyrotropin axis (1, 3, 5, 6, 8, 9). Patients with GH deficiency may exhibit fatigue or low energy as well as impaired cognition, adversely affecting quality of life (2, 8). In the recently published Hypopituitarism In Patients with Subarachnoid hemorrhage (HIPS) study, a prospective evaluation of 84 patients surviving aSAH, 39% of patients had pituitary dysfunction at their new post-aSAH baseline, 26% had pituitary dysfunction after 6 months, and 7% had pituitary dysfunction after 14 months (5). Pituitary dysfunction at follow-up did not occur in patients with normal pituitary function at their post-aSAH baseline. The most common deficiencies were in the gonadotropin and GH axes (34% and 31%, respectively). Thyroidstimulating hormone deficiency and corticotropin insufficiency (cortisol