To evaluate the hypothalamo-hypophyseal function after surgery of the ruptured anterior communicating aneurysm, the reserve of adenohypophyseal hormones (GH, ACTH, TSH, Prolactin, LH and FSH) was determined in 30 patients who had undergone microsurgical procedures. GH was studied during the insulininduced hypoglycemia. The LH, FSH, and TSH reserve was studied by means of LH-RH and TRH administration. ACTH-cortisol axis was evaluated by determining urinary 17-OHCS and serum cortisol levels. These 30 patients were divided into 3 groups based on their preoperative state of consciousness; Group A: fully alert (Grade I of Bottrell's classification, 15 cases), Group B: mildly impaired (Grade II, 10 cases) and Group C: severely damaged (Grade III to V, 5 cases). In 12 of 30 cases GH secretion was found impaired after surgery, but TSH, LH and FSH secretion were impaired only in 4 cases. Seven out of 13 cases in Group A and B had endocrine dysfunction within 3 months after subarachnoid hemorrhage (SAH) and only one of 12 cases had it thereafter. On the contrary, 2 of 5 cases in Group C was examined later than 6 months and both of them had impaired function. GH secretion was impaired in 2 out of 6 cases who had transient postoperative deterioration of consciousness and not in the other 4 cases, suggesting that the influence of microsurgical procedures on endocrine function may be slight. The hypersecretion of TSH, LH and FSH was observed in 11 out of 25 cases in Group A and B with or without impairment of other hormone secretion. None of them had hypothyroidism or hypogonadism clinically and thyroid hormone secretion was found increased in 2 cases. Morning resting levels of serum cortisol determined in 10 cases showed higher levels in 4 cases within 5 weeks after SAH and normal levels in 6 cases after 8 weeks. The pre and post-operative dexamethasone therapy did not suppress serum cortisol levels in the early phase after SAH. These data suggest that the postoperative endocrine disorders may be reversible in the state of mild impairment of consciousness and irreversible in the severely impaired state. In the former state the transient hypothalamic hyperfunction may also occur.
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