Hormonal influences on cerebral aneurysms: unraveling the complex connections

ABSTRACT

Introduction

Intracranial aneurysms (IAs) occur in 3–5% of the general population and are characterized by localized structural deterioration of the arterial wall with loss of internal elastic lamina and disruption of the media. The risk of incidence and rupture of aneurysms depends on age, sex, ethnicity, and other different factors, indicating the influence of genetic and environmental factors. When an aneurysm ruptures, there is an estimated 20% mortality rate, along with an added 30–40% morbidity in survivors. The alterations in hormonal levels can influence IAs, while the rupture of an aneurysm can have various impacts on endocrine pathways and affect their outcome.

Area covered

This review explores the reciprocal relationship between endocrinological changes (estrogen, growth hormone, and thyroid hormones) and IAs, as well as the effects of aneurysm ruptures on endocrine fluctuations.

Expert opinion

Based on the data presented in this paper, we recommend further exploration into the influence of hormones on aneurysm formation and rupture. Additionally, we propose conducting endocrine assessments for patients who have experienced a rupture of IAs. Monitoring hormonal changes in patients with IAs could serve as a potential risk factor for rupture, leading to interventions in the approach to managing IAs.

KEYWORDS:

• Brain aneurysm
• subarachnoid hemorrhage
• aneurysms
• menopause
• pregnancy
• estrogen
• thyroid hormones
• growth hormone

Article highlights

• Research examining the formation, growth, intraoperative rupture, and multiplicity of IAs consistently reveals a higher incidence in females, especially in the post-menopausal phase.

• In contrast to other stroke triggers, SAH are more prevalent in women, believed to stem from a mix of hormonal factors and variations in wall shear stress.

• Notwithstanding the negligible occurrence of intracranial aneurysms during pregnancy, physiologic alteration in pregnant women may significantly increase the rate of aneurysmal formation, growth, and, eventually, rupture.

• IAs and growth hormone (GH) can mutually influence each other. Conditions related to GH disorders may elevate the risk of forming aneurysms in the brain, while the rupture of IAs and the occurrence of SAH can lead to disruptions in growth hormone function.

• Thyroid hormones can influence the development of aneurysms, while the formation and rupture of aneurysms reciprocally impact thyroid hormone levels.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.