From the Research
Hypopituitarism can develop following intracranial hemorrhage, particularly subarachnoid hemorrhage, and requires prompt diagnosis and hormone replacement therapy. Patients with intracranial hemorrhage should be screened for pituitary dysfunction during the acute phase and in follow-up, as hypopituitarism can occur in up to 30-40% of cases 1. The standard treatment involves hormone replacement based on specific deficiencies:
- Hydrocortisone 15-25 mg daily in divided doses for adrenal insufficiency
- Levothyroxine 1.6 mcg/kg/day for hypothyroidism
- Sex hormone replacement (testosterone for men at 50-100 mg daily or estrogen/progesterone for women)
- Growth hormone replacement at individualized doses if indicated
- Desmopressin (0.1-0.4 mg daily) is needed for diabetes insipidus
The mechanism involves direct damage to the pituitary gland or hypothalamus from the hemorrhage, ischemia from vasospasm, increased intracranial pressure, or inflammatory responses 2. Regular monitoring of hormone levels is essential, with adjustments to therapy as needed. Patients should carry medical alert identification and be educated about stress dosing of glucocorticoids during illness. Early recognition and treatment of hypopituitarism after intracranial hemorrhage can significantly improve outcomes and quality of life.
Some degree of hypopituitarism appears to occur in approximately 40% of patients with moderate or severe head injury, with growth hormone and gonadotroph deficiencies being most common 2. A high degree of injury severity and secondary cerebral insults are likely risk factors for hypopituitarism. Pituitary dysfunction also occurs in patients with poor-grade aneurysms. Postacute pituitary function testing may be warranted in most patients with moderate or severe head injury, particularly those with diffuse brain swelling and those sustaining hypotensive or hypoxic insults.
It is worth noting that hypopituitarism is associated with excess mortality, a key risk factor being cortisol deficiency due to adrenocorticotropic hormone (ACTH) deficiency 3. Therefore, prompt diagnosis and treatment of hypopituitarism is crucial to improve morbidity, mortality, and quality of life.