The prevalence of growth hormone deficiency in survivors of subarachnoid haemorrhage: results from a large single centre study

Sumithra Giritharan,Kanna Gnanalingham,Joanna Cox,Calvin J Heal,Tara Kearney,David Hughes

doi:10.1007/s11102-017-0825-7

Abstract

ObjectiveThe variation in reported prevalence of growth hormone deficiency (GHD) post subarachnoid haemorrhage (SAH) is mainly due to methodological heterogeneity. We report on the prevalence of GHD in a large cohort of patients following SAH, when dynamic and confirmatory pituitary hormone testing methods are systematically employed.DesignIn this cross-sectional study, pituitary function was assessed in 100 patients following SAH. Baseline pituitary hormonal profile measurement and glucagon stimulation testing (GST) was carried out in all patients. Isolated GHD was confirmed with an Arginine stimulation test and ACTH deficiency was confirmed with a short synacthen test.ResultsThe prevalence of hypopituitarism in our cohort was 19% and the prevalence of GHD was 14%. There was no association between GHD and the clinical or radiological severity of SAH at presentation, treatment modality, age, or occurrence of vasospasm. There were statistically significant differences in terms of Glasgow Outcome Scale (GOS; p = 0.03) between patients diagnosed with GHD and those without. Significant inverse correlations between GH peak on GST with body mass index (BMI) and waist hip ratio (WHR) was also noted (p < 0.0001 and p < 0.0001 respectively).ConclusionUsing the current testing protocol, the prevalence of GHD detected in our cohort was 14%. It is unclear if the BMI and WHR difference observed is truly due to GHD or confounded by the endocrine tests used in this protocol. There is possibly an association between the development of GHD and worse GOS score. Routine endocrine screening of all SAH survivors with dynamic tests is time consuming and may subject many patients to unnecessary side-effects. Furthermore the degree of clinical benefit derived from growth hormone replacement in this patient group, remains unclear. Increased understanding of the most appropriate testing methodology in this patient group and more importantly which SAH survivors would derive most benefit from GHD screening is required.

Highlights

Subarachnoid Haemorrhage (SAH) is a rare but devastating event that occurs in about 8 to 10 per 100,000 patients per year [1]
It is unclear if the body mass index (BMI) and waist hip ratio (WHR) difference observed is truly due to Growth Hormone Deficiency (GHD) or confounded by the endocrine tests used in this protocol
All of which included BMI, gender, WHR, age, QoL-AGHDA score and Glasgow Outcome Scale (GOS) as covariates, we found the following to be positively associated with GHD: BMI, AGHDA score and hydrocephalus

Summary

Introduction

Subarachnoid Haemorrhage (SAH) is a rare but devastating event that occurs in about 8 to 10 per 100,000 patients per year [1]. Improvements in neurointensive care and the introduction of endovascular procedures have improved survival rates, with case fatality decreasing by 17% in absolute terms in the past three decades [3]. This improvement in mortality has unmasked the long term consequences of this life changing event. More recent studies report a much lower prevalence of pituitary dysfunction in this patient group [17,18,19,20,21,22] (Table 1). A recent meta-analysis has demonstrated that the pooled frequency of long term GHD is 19%, the range reported in the literature is wide, between 0 and 37% [23]

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