Hypopituitarism After Aneurismal Subarachnoid Hemorrhage
Condition: Aneurismal Subarachnoid Hemorrhage; Hypopituitarism; Neuropsychological Deficits
MeSH terms: Subarachnoid Hemorrhage; Hypopituitarism; Hemorrhage
Study type: Observational

Summary: 
      Introduction:

      Almost 50% of patients die after aneurismal subarachnoid hemorrhage (aSAH). 30% of the
      survivors suffer from neurological handicap and need permanent care (Suarez et al.). Even
      when neurological outcome is good, neuropsychological deficits are frequently observed (Ogden
      et al., Anderson et al.) The incidence rate of aSAH is almost 8 of 100.000 per year. Due to
      similar clinical symptoms to patients with hypopituitarism, several studies have analyzed the
      incidence of hypopituitarism after aSAH. Dysfunction of the anterior pituitary gland was
      found in up to 47% (Schneider et al.). GH deficiency was demonstrated in almost every fourth
      patient and an association with poor recovery was postulated. In Germany, the investigators
      would therefore expect as many as 1200 patients with incident GH deficiency. The KIMS-study
      is an observational GH-treatment study in adult onset growth hormone deficiency. Within the
      epidemiological data of KIMS, aSAH is not known as a relevant contributing cause (Brabant et
      al.). This resembles much of the investigators clinical experience that there is no huge
      prevalence of hypopituitarism after aSAH.

      Objective: Evaluation of the frequency of hypopituitarism and neuropsychological dysfunction
      of any degree in patients with aSAH in a prospective approach.

      Methods:

      The investigators conduct a prospective study for the evaluation of endocrine deficiency with
      aSAH. The investigators study patients 3, 6 and 12 month after aneurismal bleeding. Patients
      diagnosed with aSAH with a clinical grade of I-IV according to Hunt and Hess are included in
      the study. The investigators perform basal testing for the pituitary by measuring: TSH, LH,
      FSH, IGF-1, GH, prolactin and ACTH. For evaluation of the adrenal function the investigators
      perform an ACTH-stimulation test (Lindholm et al.). Subjects with evidence for adrenal or GH
      insufficiency are further analyzed by insulin-induced hypoglycemia testing (GH Research
      Society). In the neuropsychological examination, the investigators screen for verbal
      comprehension (Token Test, short form) and visual neglect (line bisection). Verbal and visual
      short term memory (digit and spatial span), visuospatial construction and figural memory (Rey
      Osterrieth Complex Figure Test), psychomotor speed, attention and concentration (Trail Making
      Test Part A and B, d2) as well as mental flexibility (word fluency) are assessed. Patients
      additionally fill out a questionnaire measuring actual depressive symptoms and anxiety
      (Hospital Anxiety and Depression Scale).
    


Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients diagnosed with aSAH with a clinical grade of I-IV according to Hunt and Hess are
        included in the study.