Hypothalamo-, Pituitary-, Adrenal Axis Dysfunction in Subarachnoid Hemorrhage

The hypotalamo-pituitary-adrenal (HPA)-axis may be affected in SAH by temporary or permanent damage to the hypothalamus and/or pituitary gland. Also surgery or endovascular treatment of a ruptured intracranial aneurysm may affect the hormonal response of the HPA-axis. Some data suggest a high incidence of delayed endocrine abnormalities in patients with SAH but only little data exists on the acute endocrine abnormalities in this disease.

We will study the pituitary-adrenal hormone levels in patients with acute aneurysmal SAH and patients admitted for elective cranial aneurysm surgery will serve as a control population. We will use serum free cortisol calculation and total cortisol measurements as well as adrenocorticotrophic hormone (ACTH) stimulation test in assessing the responsiveness of the adrenal gland to exogenous ACTH. The hormone levels will be measured repeatedly during the first seven days after SAH and once at three months.

Inclusion criteria

SAH-group:

• >age 18,
• Subarachnoid hemorrhage due to an cerebral aneurysm

Control group:

• Age >18
• Admitted for elective primary cerebral aneurysm surgery

Exclusion criteria

SAH group:

• Any corticoid treatment (also inhaled)
• Usage of etomidate before study entry or during the study period
• Exact bleeding day unknown
• Previous history of SAH or more than three days of current bleeding
• Previous aneurysm surgery or embolization
• Traumatic SAH
• Known pituitary insufficiency and moribund state of the patient
• Refusement of the patient

control group:

• Any corticoid treatment (also inhaled)
• Usage of etomidate before study entry or during the study period
• Previous history of SAH or cerebral aneurym surgery or embolization
• Admitted for elective aneurysm embolization
• Known pituitary insufficiency
• Refusement of the patienT