Reduced Quality of Life in Patients with Pituitary Dysfunction after Aneurysmal Subarachnoid Hemorrhage: A Prospective Longitudinal Study

• Published in: World neurosurgery Vol. 88; pp. 83 - 91
• Main Authors: Kronvall, Erik, MD, Sonesson, Bengt, PhD, Valdemarsson, Stig, MD, PhD, Siemund, Roger, MD, PhD, Säveland, Hans, MD, PhD, Nilsson, Ola G., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2016
• Subjects: Activities of Daily Living - psychology; Adult; Age Distribution; Aged; Aged, 80 and over; Aneurysmal subarachnoid hemorrhage; Causality; Clinical Medicine; Comorbidity; Depression - epidemiology; Depression - psychology; Female; Humans; Hypopituitarism; Klinisk medicin; Longitudinal Studies; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged; Neurologi; Neurology; Neurosurgery; Outcome; Pituitary Diseases - diagnosis; Pituitary Diseases - epidemiology; Pituitary Diseases - psychology; Pituitary dysfunction; Prospective Studies; Quality of life; Quality of Life - psychology; Risk Factors; Sex Distribution; Subarachnoid Hemorrhage - epidemiology; Subarachnoid Hemorrhage - psychology; Subarachnoid Hemorrhage - surgery; Sweden - epidemiology; Treatment Outcome; Sweden; GH; Insulin tolerance test; GHD; Subarachnoid hemorrhage; PGWB; Psychological general well-being index; ITT; hypopituitarism; GOS; Hypothalamic-pituitary-adrenal; pituitary dysfunction; Aneurysmal subarachnoid hemorrhage; QoL; PD; Glasgow outcome scale; GHRH; Growth hormone deficiency; HPA; SAH; quality of life; Growth hormone; outcome; Growth hormone releasing hormone; MRI; Pituitary dysfunction; Quality of life; PGWBI; Hypopituitarism; Outcome; NHP; BMI
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2015.12.057

Abstract Objective Pituitary dysfunction (PD) after aneurysmal subarachnoid hemorrhage (SAH) has been demonstrated in several studies. Given the similarities between psychological symptoms and reduced quality of life (QoL) in PD and fatigue commonly seen after SAH, we have investigated the relationship between QoL and PD after SAH. Methods Fifty-one patients with aneurysmal SAH were prospectively recruited and evaluated for health-related QoL using the Psychological General Well-being index. Evaluations were conducted 3-6 months (n=45), 6-12 months (n=44) and 12-24 months (n=44) after SAH, with concomitant assessment of endocrine function. The study protocol also included an MRI examination 3 months post SAH. Results Mean general well-being scores showed a positive trend from 97.3 at 3-6 months to 104.3 at 12-24 months for all patients. Multiple regression analysis identified age, sex, Hunt & Hess grade and PD as independent predictors for general well-being. Patients with PD had significantly lower scores compared to those with normal pituitary function at 3-6 months (score 85.4 versus 101.7) and 6-12 months (score 90.4 versus 105.3). This was on account of patients with central hypoadrenalism (score 81.6 at 3-6 months and score 82.2 at 6-12 months) but not other types of PD. The extent of MRI lesions had a significant negative correlation to Glasgow outcome score at all follow-up occasions. All patients with hypothalamic MRI lesions had evidence of PD at some point during follow-up. Conclusions The results support PD, and central hypoadrenalism in particular, as a contributing factor for impaired health-related QoL after SAH.