Hypopituitarism after surgical clipping of a ruptured cerebral aneurysm

Objective: The causes of hypopituitarism in adult life are most frequently cerebral tumors, pituitary infarction, head trauma, pituitary surgery, or i rradiation. We report a case of hypopituitarism after surgical clipping of a ruptured cerebral aneurysm. Two previous cases after the rupture of a cer ebral aneurysm have been reported. Design.,Case report. Patients: One 42-yr-old man. Measurements and Main Results. A 42-yr-old man was admitted as an emergency for unconsciousness. The computed tomography showed a massive subarachnoid hemorrhage, and specific angiography showed an aneurysm in the internal ca rotid. The aneurysm was successfully clipped through craniotomy. The patien t's hospital course was marked by a few episodes of pulmonary infection, an d a tracheotomy was performed. The patient was transferred to the rehabilit ation unit; he received a rating of 9 on the Glasgow Coma Scale. Seven mont hs after rupture of the aneurysm, the patient was readmitted to the intensi ve care unit for septic shock, with pulmonary infection associated with vom iting and diarrhea. Despite standard therapy and inotropic support, there w as no improvement of his clinical condition. Adrenal failure was then suspe cted. Treatment was started immediately with hydrocortisone (50 mg) four ti mes a day. Within hours, his clinical condition improved. The following mon th, the patient was weaned off his tracheotomy and had nearly recovered. En docrine tests confirmed the cortisol insufficiency but also hypothyroidism and hypogonadotropic hypogonadism secondary to hypopituitarism. Conclusion: Our case is the first one reported of hypopituitarism after sur gical clipping of a ruptured cerebral aneurysm.