Neurocritical Care

, 15:365 | Cite as

SAH Pituitary Adrenal Dysfunction

  • P. VespaEmail author
  • The Participants in the International Multi-disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage


Disruption of the hypothalamic–pituitary–adrenal axis may occur after aneurysmal subarachnoid hemorrhage, resulting in hypopituitarism. An electronic literature search was conducted to identify articles with English-language abstracts published between 1980 and March 2011 that addressed hypothalamic–pituitary–adrenal axis insufficiency and hormone replacement. A total of 18 observational and prospective, randomized studies were selected for this review. Limited data are available evaluating pituitary effects during the acute stage after subarachnoid hemorrhage, with inconsistent results reported. Overall, acutely after subarachnoid hemorrhage, cortisol levels may initially be supranormal, decreasing toward normal levels over time. During the months to years after subarachnoid hemorrhage, pituitary deficiency may occur in up to one in three patients. Limited data suggest modest outcome benefits with fludrocortisone and no benefit or harm from corticosteroids.


Adrenal insufficiency Adrenocorticotropic hormone Cortisol Growth hormone Hypothalamic 


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • P. Vespa
    • 1
    • 2
    Email author
  • The Participants in the International Multi-disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage
  1. 1.Department of NeurosurgeryUniversity of California at Los AngelesLos AngelesUSA
  2. 2.David Geffen School of Medicine at UCLAUniversity of CaliforniaLos AngelesUSA

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