Endocrine disorders after aneurysmal subarachnoid hemorrhage: Acute neuroendocrine responses and long-term sequelae. A narrative review

Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening cerebrovascular event associated with profound neurological and systemic disturbances. Among these, alterations in hypothalamic-pituitary function, water-electrolyte balance, and glucose metabolism are frequently observed but remain difficult to interpret, particularly in the setting of critical illness. Many endocrine abnormalities detected during the acute phase reflect adaptive neuroendocrine stress responses rather than true hormonal failure, whereas persistent deficiencies may emerge during recovery and contribute to long-term morbidity. This narrative review summarizes current evidence on endocrine disturbances after aSAH, emphasizing the distinction between acute neurocritical care physiology and chronic endocrine sequelae. We discuss the hypothalamic-pituitary-adrenal (HPA), thyroid, somatotropic, and gonadal axes, as well as dysnatremia and stress hyperglycemia, addressing their prevalence, pathophysiological background, diagnostic challenges, and therapeutic considerations in both intensive care unit (ICU) and post-acute settings. Available data remain heterogeneous and largely observational. Current evidence does not support routine hormonal intervention during the acute phase except in clearly defined endocrine emergencies. Careful interpretation of biochemical findings and structured endocrine follow-up after neurological stabilization appear essential for identifying clinically meaningful long-term dysfunction.