Accepted Manuscript Hypocortisolism: an underestimated complication of Subarachnoid Haemorrhage Luigi A. Lanterna , MD, PhD Carlo Brembilla , MD Paolo Gritti , MD PII:

S1878-8750(14)00472-0

DOI:

10.1016/j.wneu.2014.05.013

Reference:

WNEU 2368

To appear in:

World Neurosurgery

Received Date: 4 May 2014 Accepted Date: 9 May 2014

Please cite this article as: Lanterna LA, Brembilla C, Gritti P, Hypocortisolism: an underestimated complication of Subarachnoid Haemorrhage, World Neurosurgery (2014), doi: 10.1016/ j.wneu.2014.05.013. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT Hypocortisolism: an underestimated complication of Subarachnoid Haemorrhage

Luigi A Lanterna, MD, PhD;1 Carlo Brembilla, MD;1 Paolo Gritti, MD2

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(1) Department of Neuroscience and Surgery of the Nervous System, Papa Giovanni XXIII Hospital, Bergamo, Italy

(2) Department of Anesthesia - Anesthesia and Intensive Care IV, Papa Giovanni XXIII Hospital,

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Bergamo, Italy

Corresponding Author: Luigi A Lanterna, MD, PhD

Department of Neuroscience and Surgery of the Nervous System

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Papa Giovanni XXIII Hospital Bergamo, Italy

Letter:

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[email protected]

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We have read with great interest the article by Kronvall et al (2) regarding pituitary dysfunction after aneurysmal subarachnoid hemorrhage (SAH). The authors are to be commended for having investigated the pituitary function during the acute phase of SAH. The authors included 51 patients and studied the endocrine function at 5 to 10 days after SAH and at 3 to 6 months. The authors found an overall prevalence of endocrine dysfunction of 37% during the acute phase and of 27% at follow-up. The study concluded that pituitary dysfunction may be associated with a higher risk of poor outcome (2).

ACCEPTED MANUSCRIPT We would like to point out some methodological concerns regarding the prevalence of adrenal axis deficiency that was diagnosed in only 8% of the patients during the acute phase (2). It is possible that the methodology of the study may have lead to an underestimation of the burden of hypocortisolism and its relative risks. In particular, the blood sampling schedule that consisted in a

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single assessment may have been a significant drawback. We have recently published a prospective study dealing with the prevalence of hypocortisolism during the acute phase of SAH. Hypocortisolism was defined according to international consensus statements: random total cortisol

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Hypocortisolism: an underestimated complication of subarachnoid hemorrhage.

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