Prevalence of Pituitary Dysfunction After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

Background: As a common complication after aneurysmal subarachnoid hemorrhage, the prevalence of pituitary dysfunction ranges widely at the global level and has not been synthesized by meta-analysis for a few years. Updated estimates of the prevalence of pituitary dysfunction after aneurysmal subarachnoid hemorrhage are urgently needed to improve recognition and attention from medical. Methods We comprehensively searched four literature databases including Scopus, Embase, Web of Science and PubMed, and performed a random-effects meta-analysis for the search results. Heterogeneity in the prevalence estimates was analyzed by subgroup analysis in terms of WHO region and type of pituitary dysfunction. Results 27 studies with 1848 subjects were included in this study. The pooled prevalence of pituitary dysfunction in the acute phase was 49.6% (95% CI, 32.4%-66.8%), and decreased in the chronic phase to 30.4% (95% CI, 21.4%-39.4%). Among the hormonal deficiencies, growth hormone dysfunction was the most prevalent in the acute phase with 36.0% (95% CI, 21.0%-51.0%), and in the chronic phase was hypoadrenalism accounting for 21.0% (95% CI, 12.0%-29.0%). While referring to the WHO region, the prevalence of pituitary dysfunction in the acute phase was the highest in SEARO, up to 81.0% (95%CI, 77.0%-86.0%), while the EURO with the highest prevalence of pituitary dysfunction in the chronic phase, was only 33.0% (95%CI, 24.0%-43.0%). Moreover, single pituitary hormone dysfunction occurred more frequently than that of multiple regardless of in the acute or chronic phase. Conclusions In up to 49.6%, patients with aneurysmal subarachnoid hemorrhage may be complicated with pituitary dysfunction, which deserved more attention. Although the prevalence decreased over time, early detection and early treatment were more beneficial for the quality of life of patients. However, the number of existing studies on PD after aSAH is limited. Therefore, more studies based on larger populations and countries are necessary to provide early warning.