Volume 17 Supplement 2

33rd International Symposium on Intensive Care and Emergency Medicine

Open Access

Prevalence of pituitary disorders associated with aneurysmal subarachnoid hemorrhage

  • F Lauzier1,
  • I Cote1,
  • A Bureau1,
  • M Shemilt1,
  • A Boutin1,
  • L Moore1,
  • C Gagnon1 and
  • AF Turgeon1
Critical Care201317(Suppl 2):P342

DOI: 10.1186/cc12280

Published: 19 March 2013

Introduction

Pituitary disorders are an often-neglected consequence of aneurysmal subarachnoid hemorrhage (aSAH). We systematically reviewed their prevalence, aiming particularly at studies with low risk of bias.

Methods

We searched Embase, MEDLINE, The Cochrane Library, Trip Database, references of included studies and narrative reviews. We included cohort studies, cross-sectional studies and RCTs published in any language that tested the integrity of ≥1 pituitary axis in adults with aSAH. Studies including more than 50% of non-aneurismal SAH were excluded. Studies were considered at low risk of bias if the authors defined inclusion/exclusion criteria, avoided voluntary sampling, and tested >90% of included patients with proper detailed diagnostic criteria. Studies testing all pituitary axes were considered as evaluating hypopituitarism, which was defined as the dysfunction of ≥1 axis. We used a Freeman Tukey-type arcsine square-root transformation and pooled prevalences using the DerSimonian-Laird random-effect method. We determined the degree of heterogeneity with I 2 values.

Results

Among 12,363 citations, we included 28 studies (1,628 patients). Patients were mostly female (64%) aged 50.5 ± 5.4. Sixteen studies reported the severity of aSAH, 14 reported the procedure for securing the aneurysm and 13 reported the location of aneurysm. Overall, hypopituitarism was observed in 53.4% of patients at short-term (<3 months), 36.5% at mid-term (3 to 12 months) and 34.2% at long-term (>12 months) (Table 1). There was an insufficient number of studies with low risk of bias to perform sensitivity analyses according to study quality.
Table 1

abstractP342

 

Hypopituitarism

GH

ACTH

TSH

Gonadal

ADH

Short term

      

All studies

53.4% (20.5 to 84.7)

30.4% (11.5 to 53.2)

13.2% (4.4 to 25.1)

49.2% (0.1 to 17.7)

26.1% (8.8 to 48.0)

6.3% (2.7 to 11.0)

n (patients)

5 (235)

8 (346)

13 (537)

7 (327)

8 (351)

3 (481)

I 2

96.0%

93.5%

90.2%

89.1%

93.0%

61.1%

Studies of low risk of bias (patients)

2(56)

-

-

2(56)

1(26)

-

Mid-term

      

All studies

36.5% (13.6 to 62.8)

7.3% (0.6 to 18.3)

8.9% (1.3 to 21.0)

8.8% (2.4 to 18.0)

3.9% (0.0 to 11.9)

3.7% (0.6 to 13.5)

n (patients)

4 (109)

6 (158)

7 (208)

5 (176)

6 (178)

2(56)

I 2

85.7%

70.9%

79.4%

59.4%

66.8%

29.0%

Studies with low risk of bias (patients)

1(40)

-

-

1(40)

-

-

Long-term

      

All studies

34.2% (18.7 to 51.4)

17.1% (9.4 to 26.4)

11.2% (4.8 to 19.4)

2.3% (0.4 to 5.3)

3.2% (0.7 to 6.8)

0% (0 to 1.5)

n (patients)

12 (486)

13 (531)

13 (531)

12 (486)

13(351)

3 (142)

I 2

92.5%

82.9%

82.9%

49.0%

62.9%

0%

Studies with low risk of bias (patients)

2(40)

2(40)

2(40)

2(40)

1(10)

-

Conclusion

The exact prevalence of pituitary disorders following aSAH remains uncertain, mainly due to high heterogeneity and the small number of studies with low risk of bias. However, the prevalence seems to decrease during the recovery phase. The prevalence, risk factors and clinical significance of pituitary disorders in aSAH will require further rigorous evaluation.

Authors’ Affiliations

(1)
Universite Laval

Copyright

© Lauzier et al.; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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