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Can cardiac surgery cause hypopituitarism?

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Abstract

Apoplexy of pituitary adenomas with subsequent hypopituitarism is a rare but well recognized complication following cardiac surgery. The nature of cardiac on-pump surgery provides a risk of damage to the pituitary because the vascular supply of the pituitary is not included in the cerebral autoregulation. Thus, pituitary tissue may exhibit an increased susceptibility to hypoperfusion, ischemia or intraoperative embolism. After on-pump procedures, patients often present with physical and psychosocial impairments which resemble symptoms of hypopituitarism. Therefore, we analyzed whether on-pump cardiac surgery may cause pituitary dysfunction also in the absence of pre-existing pituitary disease. Twenty-five patients were examined 3–12 months after on-pump cardiac surgery. Basal hormone levels for all four anterior pituitary hormone axes were measured and a short synacthen test and a growth hormone releasing hormone plus arginine (GHRH-ARG)-test were performed. Quality of life (QoL), depression, subjective distress for a specific life event, sleep quality and fatigue were assessed by means of self-rating questionnaires. Hormonal alterations were only slight and no signs of anterior hypopituitarism were found except for an insufficient growth hormone rise in two overweight patients in the GHRH-ARG-test. Psychosocial impairment was pronounced, including symptoms of moderate to severe depression in 9, reduced mental QoL in 8, dysfunctional coping in 6 and pronounced sleep disturbances in 16 patients. Hormone levels did not correlate with psychosocial impairment. On-pump cardiac surgery did not cause relevant hypopituitarism in our sample of patients and does not serve to explain the psychosocial symptoms of these patients.

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Acknowledgments

The study was performed as the doctoral thesis of the first author (FF). She would like to thank the authors of the questionnaires for granting permission to use the following not commercially available questionnaires: PSQI (German version): Prof. Dr. Jutta Backhaus, IES-R: Prof. Dr. med. Dr. phil. A. Maercker, FIS-D: Dr. med. Winfried Häuser. The authors also gratefully acknowledge the assistance of the study nurse, Manuela Langheimer. This work was partly supported by a grant from Novo Nordisk Pharma GmbH, Brucknerstr. 1, 55127 Mainz, Germany.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

The study was approved by the local ethics committee of the University of Technology, RWTH Aachen and was carried out according to the Declaration of Helsinki.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany

    Flverly Francis, Eva Maria Poll, Andrea Reineke, Joachim M. Gilsbach & Ilonka Kreitschmann-Andermahr

  2. Department of Cardiothoracic Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany

    Ines Burger & Guido Dohmen

  3. Division of Endocrinology, Department of Internal Medicine, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany

    Christian J. Strasburger

  4. Department of Neurosurgery, University of Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany

    Ilonka Kreitschmann-Andermahr

Authors
  1. Flverly Francis
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  2. Ines Burger
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  3. Eva Maria Poll
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  4. Andrea Reineke
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  5. Christian J. Strasburger
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  6. Guido Dohmen
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  7. Joachim M. Gilsbach
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  8. Ilonka Kreitschmann-Andermahr
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Correspondence to Ilonka Kreitschmann-Andermahr.

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Francis, F., Burger, I., Poll, E.M. et al. Can cardiac surgery cause hypopituitarism?. Pituitary 15, 30–36 (2012). https://doi.org/10.1007/s11102-011-0322-3

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  • DOI: https://doi.org/10.1007/s11102-011-0322-3

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