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This article is part of the supplement: 33rd International Symposium on Intensive Care and Emergency Medicine

Poster presentation

Prevalence of pituitary disorders associated with aneurysmal subarachnoid hemorrhage

F Lauzier*, I Cote, A Bureau, M Shemilt, A Boutin, L Moore, C Gagnon and AF Turgeon

  • * Corresponding author: F Lauzier

Author Affiliations

Universite Laval, Quebec, Canada

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Critical Care 2013, 17(Suppl 2):P342  doi:10.1186/cc12280


The electronic version of this article is the complete one and can be found online at: http://ccforum.com/content/17/S2/P342


Published:19 March 2013

© 2013 Lauzier et al.; licensee 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.

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 I2 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.

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.