Abstract
Hypopituitarism is a common complication of both traumatic brain injury and subarachnoid haemorrhage and there is increasing evidence that a significant number of patients recovering from ischaemic stroke may also exhibit some degree of pituitary dysfunction.
This paper describes a prospective study of 56 patients (34 men; mean age 64.8 ± 1.3 y; mean body mass index 25.8 ± 0.45 kg/m2) who had suffered an ischaemic stroke. The aims of the study were to determine the incidence and pattern of pituitary dysfunction during stroke recovery and also to define criteria which may identify patients at higher risk of developing hypopituitarism. Stroke severity was assessed clinically at the time of stroke (baseline) and also by computed tomography scan at baseline and 48 h later. Patients underwent an endocrine assessment 1–3 months (visit one) and 12–15 months (visit two) after the initial event.
Hypopituitarism was diagnosed in almost 40% of the patients at both visits. Growth hormone deficiency (GHD) was the most common defect, with almost one-third of patients exhibiting GHD. A small number of cases of central hypogonadism (6 patients) and adrenocorticotrophic hormone deficiency (1 patient) were also identified. No cases of central hypothyroidism or diabetes insipidus were detected. Hypopituitarism persisted through to visit 2 in most cases, with only four patients recovering normal pituitary function. In addition, three new cases of GHD developed between visits 1 and 2.
Signs and symptoms of pituitary deficiency may be masked by other stroke sequelae and therefore many cases of hypopituitarism in stroke patients may remain undiagnosed, potentially affecting functional outcome and quality of life. The results from this study identified a number of risk factors for the development of hypopituitarism after stroke. These include stroke severity, the presence of diabetes mellitus and the occurrence of medical complications during hospitalization. The authors suggest that these risk factors may provide a cost-effective approach to help select patients needing an accurate endocrine evaluation to improve stroke outcome.