Endocrine Function Following Acute SAH
- PDF / 162,605 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 77 Downloads / 190 Views
REVIEW
Endocrine Function Following Acute SAH Paul Vespa • The Participants in the International Multi-disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage
Published online: 2 August 2011 Ó Springer Science+Business Media, LLC 2011
Abstract Disruption of the hypothalamic–pituitary– adrenal axes 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, which 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 being reported. Overall, after acute 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 one out of three patients. Limited data suggest modest outcome benefits with fludrocortisone and no benefit or harm from corticosteroids.
The Participants in the International Multi-disciplinary Consensus Conference: Michael N. Diringer, Thomas P. Bleck, Nicolas Bruder, E. Sander Connolly, Jr., Giuseppe Citerio, Daryl Gress, Daniel Hanggi, J. Claude Hemphill, III, MAS, Brian Hoh, Giuseppe Lanzino, Peter Le Roux, David Menon, Alejandro Rabinstein, Erich Schmutzhard, Lori Shutter, Nino Stocchetti, Jose Suarez, Miriam Treggiari, MY Tseng, Mervyn Vergouwen, Paul Vespa, Stephan Wolf, Gregory J. Zipfel. P. Vespa (&) Division of Neurosurgery, David Geffen School of Medicine at UCLA, University of California, Room 6236A Ronald Reagan UCLA Medical Center, 750 Westwood Blvd, Los Angeles, CA 90095, USA e-mail: [email protected]
Keywords Adrenal insufficiency Adrenocorticotropic hormone Cortisol Growth hormone Hypothalamic
Introduction Aneurysmal subarachnoid hemorrhage (SAH) presents with widespread medical complications that include disruption of the hypothalamic–pituitary–adrenal (HPA) axis. Sodium imbalance in SAH related to the syndrome of inappropriate antidiuretic hormone secretion or cerebral salt wasting syndrome is addressed elsewhere (see Chapter Hyponatremia). Hypopituitarism may occur following brain injury, including after SAH [1–3]. An initial surge in the sympathetic nervous system is associated with the release of catecholamines and cortisol. Dysfunction of the HPA can result in acute physiological problems in the critical care setting and potentially in long-lasting effects on cognitive outcome after SAH [4, 5]. This study was designed to evaluate the incidence and consequences of HPA insufficiency in patients with SAH. The literature was also reviewed for investigating whether acute hormonal replacement therapy is beneficial for the SAH patient, including the use of corticosteroids for the
Data Loading...
