Sheehan syndrome: metabolic and hormonal abnormalities (46 cases)
Hadj Ali Insaf, Haouat Emna, Mchirgui Nadia, Khiari Karima, Lakhoua Youssef & Ben Abdallah Nejib
Sheehan syndrome is a global or partial pituitary defect occurring after an obstetrical haemorrhage.
The aim of this study is to describe metabolic complications in 46 consecutive patients with Sheehan syndrome and to determine correlations between these complications and the clinical, hormonal and therapeutic aspects of this syndrome.
All patients have had a physical examination: weight measurement, body mass index (BMI) determination and blood pressure measurement. Fasting plasma glucose and lipid profile are realised in all cases as well as hormonal investigation of the pituitary gland.
Mean age at diagnosis is 39.3 years. Mean delay between the obstetrical event and diagnosis is 7.6 years. None patient had arterial hypertension anterior to the diagnosis of Sheehan syndrome.
At the diagnosis, mean BMI is 23 kg/m2. An overweight is found in 15.2% of patients (n=7) and obesity in 8.8% of them (n=4). Hypertension is found in 4.4% of patients (n=2). Glucose intolerance or diabetes is found in respectively 13.2 and 4.3% of them. Hypercholesterolemia and hyper triglyceridemia are present in 43.3 and 32.6% of patients.
The number of pituitary axis affected is 3 in 20 patients, four in 12 patients, two in 10 patients, one in 3 patients and a panhypopituitarism is found in one patient. Most affected axis are: gonadotrope (89.1%), corticotrope (80.4%), and thyreotrope axis (74%). Hypertension appeared in 31.5% of patients (n=12), diabetes in 23.6% of them, hypercholesterolemia in 30% and hyper triglyceridemia in 25% of them.
Our results confirm the high prevalence of metabolic troubles in Sheehan syndrome. Hyperlipidemia seems to be directly in relation to somatotrope and thyreotrope defects.