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Clinical prevalence and outcome impact of pituitary dysfunction after aneurysmal subarachnoid hemorrhage: a systematic review with meta-analysis

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Abstract

Purpose

Pituitary dysfunction is reported to be a common complication following aneurysmal subarachnoid hemorrhage (aSAH). The aim of this meta-analysis is to analyze the literature on clinical prevalence, risk factors and outcome impact of pituitary dysfunction after aSAH, and to assess the possible need for pituitary screening in aSAH patients.

Methods

We performed a systematic review with meta-analysis based on a comprehensive search of four databases (PubMed/MEDLINE, ISI/Web of Science, Scopus and Google Scholar).

Results

A total of 20 papers met criteria for inclusion. The prevalence of pituitary dysfunction in the acute phase (within the first 6 months after aSAH) was 49.30 % (95 % CI 41.6–56.9), decreasing in the chronic phase (after 6 months from aSAH) to 25.6 % (95 % CI 18.0–35.1). Abnormalities in basal hormonal levels were more frequent when compared to induction tests, and the prevalence of a single pituitary hormone dysregulation was more frequent than multiple pituitary hormone dysregulation. Increasing age was associated with a lower prevalence of endocrine dysfunction in the acute phase, and surgical treatment of the aneurysm (clipping) was related to a higher prevalence of single hormone dysfunction. The prevalence of pituitary dysfunction did not correlate with the outcome of the patient.

Conclusions

Neuroendocrine dysfunction is common after aSAH, but these abnormalities have not been shown to consistently impact outcome in the data available. There is a need for well-designed prospective studies to more precisely assess the incidence, clinical course, and outcome impact of pituitary dysfunction after aSAH.

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Acknowledgments

The authors would like to thank Dr. Fabio Gallo from the University of Genoa, Italy for the fundamental help in the meta-analysis.

Author contributions

Dr. Robba contributed to the concept and design of the manuscript, to data acquisition and interpretation of data and writing of the manuscript. Dr. Bacigaluppi contributed to concept and design of the manuscript, data acquisition and interpretation, and critical revision of the paper. Dr. Bragazzi contributed to the concept and design of the manuscript, data revision and analysis and critical revision of the paper. Dr Lavinio and Dr Bilotta revised the article critically for important intellectual content. Dr David Menon and Mark Gurnell contributed to the concept and design and writing of the manuscript and supervised the study.

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    Authors and Affiliations

    1. Neurosciences Critical Care Unit, Addenbrooke’s Hospital, Cambridge University, Cambridge University Hospitals Trust, Box 1, Hills Road, Cambridge, CB2 0QQ, UK

      Chiara Robba, Andrea Lavinio & David K. Menon

    2. Department of Neurosurgery, Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy

      Susanna Bacigaluppi

    3. Department of Health Sciences (DISSAL), University of Genoa, Largo Rosanna Benzi, 15, 16100, Genoa, Italy

      Nicola Bragazzi

    4. Department of Medicine, Addenbrooke’s Hospital, Cambridge University, Cambridge University Hospitals Trust, Box 1, Hills Road, Cambridge, CB2 0QQ, UK

      Mark Gurnell

    5. Department of Anesthesiology, University of Rome “La Sapienza”, Piazzale Aldo Moro 5, 00185, Rome, Italy

      Federico Bilotta

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    1. Chiara Robba
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    Correspondence to Chiara Robba.

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    Susanna Bacigaluppi and Nicola Bragazzi have contributed equally to this work.

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    Robba, C., Bacigaluppi, S., Bragazzi, N. et al. Clinical prevalence and outcome impact of pituitary dysfunction after aneurysmal subarachnoid hemorrhage: a systematic review with meta-analysis. Pituitary 19, 522–535 (2016). https://doi.org/10.1007/s11102-016-0733-2

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