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Das L, Laway BA, Sahoo J, Dhiman V, Singh P, Rao SD, Korbonits M, Bhadada SK, Dutta P. Bone mineral density, turnover, and microarchitecture assessed by second-generation high-resolution peripheral quantitative computed tomography in patients with Sheehan's syndrome. Osteoporos Int 2024; 35:919-927. [PMID: 38507080 DOI: 10.1007/s00198-024-07062-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/07/2024] [Indexed: 03/22/2024]
Abstract
Sheehan's syndrome (SS) is a rare but well-characterized cause of hypopituitarism. Data on skeletal health is limited and on microarchitecture is lacking in SS patients. PURPOSE We aimed to explore skeletal health in SS with bone mineral density (BMD), turnover, and microarchitecture. METHODS Thirty-five patients with SS on stable replacement therapy for respective hormone deficiencies and 35 age- and BMI-matched controls were recruited. Hormonal profile and bone turnover markers (BTMs) were measured using electrochemiluminescence assay. Areal BMD and trabecular bone score were evaluated using DXA. Bone microarchitecture was assessed using a second-generation high-resolution peripheral quantitative computed tomography. RESULTS The mean age of the patients was 45.5 ± 9.3 years with a lag of 8.3 ± 7.2 years prior to diagnosis. Patients were on glucocorticoid (94%), levothyroxine (94%), and estrogen-progestin replacement (58%). None had received prior growth hormone (GH) replacement. BTMs (P1NP and CTX) were not significantly different between patients and controls. Osteoporosis (26% vs. 16%, p = 0.01) and osteopenia (52% vs. 39%, p = 0.007) at the lumbar spine and femoral neck (osteoporosis, 23% vs. 10%, p = 0.001; osteopenia, 58% vs. 29%, p = 0.001) were present in greater proportion in SS patients than matched controls. Bone microarchitecture analysis revealed significantly lower cortical volumetric BMD (vBMD) (p = 0.02) at the tibia, with relative preservation of the other parameters. CONCLUSION Low areal BMD (aBMD) is highly prevalent in SS as compared to age- and BMI-matched controls. However, there were no significant differences in bone microarchitectural measurements, except for tibial cortical vBMD, which was lower in adequately treated SS patients.
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Affiliation(s)
- Liza Das
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
- Department of Telemedicine, PGIMER, Chandigarh, India
| | - Bashir Ahmad Laway
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Jayaprakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Vandana Dhiman
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | | | - Sudhaker Dhanwada Rao
- Division of Endocrinology, Metabolism and Bone and Mineral Disorders, and Bone and Mineral Research Laboratory, Henry Ford Health, Detroit, MI, USA
- Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Márta Korbonits
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Pinaki Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
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de Sá Cavalcante D, da Silva Castro MG, Quidute ARP, Martins MRA, Cid AMPL, de Barros Silva PG, Cadwell Williams J, Neves FS, Ribeiro TR, Costa FWG. Evaluation of bone texture imaging parameters on panoramic radiographs of patients with Sheehan's syndrome: a STROBE-compliant case-control study. Osteoporos Int 2019; 30:2257-2269. [PMID: 31372710 DOI: 10.1007/s00198-019-05086-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
Abstract
UNLABELLED Sheehan's syndrome (SHS) is a rare condition related to the risk of osteoporosis and evaluation of bone texture imaging features on panoramic radiographs would be suitable for this condition, which was the aim of the present study. Fractal dimension, lacunarity, and trabecular morphologic aspects were significantly altered in these patients. INTRODUCTION SHS is an important public health problem particularly in developing countries. It is characterized as postpartum hypopituitarism secondary to obstetric complications-related ischemic pituitary necrosis that shows significant systemic metabolic repercussions. Thus, this study aimed to evaluate bone texture parameters in digital panoramic radiographs of patients with SHS. METHODS A case-control study was conducted with 30 SHS patients from an Endocrinology and Diabetology Service of reference in Brazil, and 30 age- and sex-matched healthy controls. A custom computer program measured fractal dimension, lacunarity, and some morphologic features in the following mandibular regions of interest (50 × 50 pixels): below the mental foramen (F1), between the first and second molars (M1), and at the center of the mandibular ramus (R1). RESULTS The fractal analysis showed a statistically significant difference between the studied groups in all regions of interest. The fractal dimension in F1 (p = 0.016), M1 (p = 0.043), and R1 (p = 0.028) was significantly lower in SHS group, as well as lacunarity in R1 (p = 0.008). Additionally, several morphologic features were statistically significant in the SHS group (p < 0.05). CONCLUSION Therefore, individuals with SHS showed altered imaging texture parameters on panoramic radiographs, which reflect a smaller spatial organization of the bone trabeculae and, possibly, a state of reduced mineral bone density.
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Affiliation(s)
- D de Sá Cavalcante
- Department of Clinical Dentistry, Postgraduate Program in Dentistry, Federal University of Ceará, Alexandre Baraúna St 949, Rodolfo Teofilo, Fortaleza, Ceará, 60430-160, Brazil
| | - M G da Silva Castro
- Realistic Simulation Center, Univeristy Center UNICHRISTUS, R. João Adolfo Gurgel St 133, Cocó, Fortaleza, Ceará, 60190-060, Brazil
| | - A R P Quidute
- Division of Endocrinology and Diabetology, Walter Cantídio University Hospital, Alexandre Baraúna St 949, Rodolfo Teofilo, Fortaleza, Ceará, 60430-160, Brazil
| | - M R A Martins
- Division of Endocrinology and Diabetology, Walter Cantídio University Hospital, Alexandre Baraúna St 949, Rodolfo Teofilo, Fortaleza, Ceará, 60430-160, Brazil
| | - A M P L Cid
- Department of Clinical Dentistry, Postgraduate Program in Dentistry, Federal University of Ceará, Alexandre Baraúna St 949, Rodolfo Teofilo, Fortaleza, Ceará, 60430-160, Brazil
| | - P G de Barros Silva
- Department of Clinical Dentistry, Postgraduate Program in Dentistry, Federal University of Ceará, Alexandre Baraúna St 949, Rodolfo Teofilo, Fortaleza, Ceará, 60430-160, Brazil
| | - J Cadwell Williams
- Department of Anatomy and Cell Biology, Indiana School of Medicine, 635 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - F S Neves
- Division of Oral Radiology, School of Dentistry, Federal University of Bahia, Araújo Pinho ave 62, Canela, Salvador, Bahia, 40110-040, Brazil
| | - T R Ribeiro
- Department of Clinical Dentistry, Postgraduate Program in Dentistry, Federal University of Ceará, Alexandre Baraúna St 949, Rodolfo Teofilo, Fortaleza, Ceará, 60430-160, Brazil
| | - F W G Costa
- Department of Clinical Dentistry, Postgraduate Program in Dentistry, Federal University of Ceará, Alexandre Baraúna St 949, Rodolfo Teofilo, Fortaleza, Ceará, 60430-160, Brazil.
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Agarwal P, Gomez R, Bhatia E, Yadav S. Decreased bone mineral density in women with Sheehan's syndrome and improvement following oestrogen replacement and nutritional supplementation. J Bone Miner Metab 2019; 37:171-178. [PMID: 29464357 DOI: 10.1007/s00774-018-0911-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/23/2018] [Indexed: 11/29/2022]
Abstract
Sheehan's syndrome (SS) is an important cause of pan-hypopituitarism in women. There is scanty information on bone mineral density (BMD) in this condition. We determined BMD and the changes in BMD after oestrogen (E2) replacement and nutritional supplementation in women with SS. In a cross-sectional study, BMD was measured by DEXA in 83 patients [age (mean ± SD) 42 ± 9.2 years] and compared with an equal number of matched controls. In a sub-set of 19 patients, we conducted an open-label, prospective study to determine changes in BMD after 1 year of replacement of E2, and calcium and vitamin D3 supplementation. All patients had low serum IGF-1 and E2, while 98% had ≥ 3 pituitary hormone deficiencies. Compared with Indian reference standards, 47% had decreased bone mass (Z-score ≤ - 2.0). BMD Z-scores were decreased at all sites, being most marked in the lumbar spine and femoral neck. At the lumbar spine, BMD was lowest among the age group 21-30 years. Women with SS also had significantly lower BMD Z-scores at all three sites on comparison with ethnic controls. On multivariate analysis, BMD Z-score was associated with weight, daily calcium intake and age (lumbar spine). In the prospective study, 1 year of therapy improved BMD Z-score at lumbar spine (- 1.4 ± 1.2 vs. - 1.1 ± 1.1, p = 0.02), but not at hip or femoral neck. In conclusion, patients with SS had significantly lower BMD compared to controls at all three sites. Replacement of E2 and supplementation with calcium/vitamin D3 lead to significant improvement in lumbar spine BMD.
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Affiliation(s)
- Purnima Agarwal
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Ramesh Gomez
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Eesh Bhatia
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Subhash Yadav
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
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Cavalcante DDS, Pinto-Quidute AR, Alves-Martins MR, Walter-de-Aguiar AS, Lima-Cid AMP, Silva PGB, Cavalcante RF, Costa FWG. Dental status, salivary flow, and sociodemographic aspects in Sheehan Syndrome patients. Med Oral Patol Oral Cir Bucal 2018; 23:e436-e442. [PMID: 29924763 PMCID: PMC6051684 DOI: 10.4317/medoral.22377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/25/2018] [Indexed: 11/17/2022] Open
Abstract
Background Sheehan’s syndrome (SS) is one of the leading causes of hypopituitarism in developing countries. It occurs after postpartum necrosis of the pituitary gland, and it is considered a significant public health problem. This paper, apparently unpublished, aimed to perform an analysis on oral aspects in patients with SS. Material and Methods A cross-sectional study was performed with 23 women diagnosed with SS at the Division of Endocrinology and Diabetes (Walter Cantídio University Hospital, Fortaleza, Brazil). Results Data on sociodemographic, dental and salivary flow aspects were collected through a clinical approach and a panoramic radiograph request. The mean age was 64 ± 11.5 years old, with the sample consisting mainly of married women (56.5%), socioeconomic class C2 or D / E (78.2%) and years of education up to 8 years (69.5%). The presence of horizontal bone loss (p<0.001) and bilateral pneumatization of the maxillary sinus (p=0.015) were significant data. The mean number of absent teeth considering all subjects was 23.17±9.7, being statistically significant (p<0.001). In relation to age, the mean number of missing teeth was higher in individuals over 65 years old (p=0.048). Reduced salivary flow was observed in 78.3% of the patients. In a bivariate analysis, considering the outcome variables “missing teeth” and “reduced salivary flow”, it was observed that economic class (p<
0.001), family income (0.037) and maxillary sinus pneumatization (0.032) were statistically significant. Conclusions In brief, patients with SS showed severe teeth loss, reduced salivary flow, and low educational status. This study addressed important aspects regarding oral findings in SS and highlighted the importance of researches in oral medicine. Key words:Sheehan’s Syndrome, hypopituitarism, tooth loss, salivary flow.
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Affiliation(s)
- D-D-S Cavalcante
- Alexandre Barauna, 949 Rodolfo Teofilo, 60430-160 Fortaleza, Ceara, Brazil, Federal University of Ceara, Department of Clinical Dentistry, School of Dentistry,
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Abstract
Sheehan syndrome or postpartum hypopituitarism is a condition characterized by hypopituitarism due to necrosis of the pituitary gland. The initial insult is caused by massive postpartum haemorrhage (PPH), leading to impaired blood supply to the pituitary gland, which has become enlarged during pregnancy. Small sella turcica size, vasospasms (caused by PPH) and/or thrombosis (associated with pregnancy or coagulation disorders) are predisposing factors; autoimmunity might be involved in the progressive worsening of pituitary functions. Symptoms are caused by a decrease or absence of one or more of the pituitary hormones, and vary, among others, from failure to lactate and nonspecific symptoms (such as fatigue) to severe adrenal crisis. In accordance with the location of hormone-secreting cells relative to the vasculature, the secretion of growth hormone and prolactin is most commonly affected, followed by follicle-stimulating hormone and luteinizing hormone; severe necrosis of the pituitary gland also affects the secretion of thyroid-stimulating hormone and adrenocorticotropic hormone. Symptoms usually become evident years after delivery, but can, in rare cases, develop acutely. The incidence of Sheehan syndrome depends, to a large extent, on the occurrence and management of PPH. Sheehan syndrome is an important cause of hypopituitarism in developing countries, but has become rare in developed countries. Diagnosis is based on clinical manifestations combined with a history of severe PPH; hormone levels and/or stimulation tests can confirm clinical suspicion. Hormone replacement therapy is the only available management option so far.
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Affiliation(s)
- Züleyha Karaca
- Department of Endocrinology, Erciyes University Medical School, 38039, Kayseri, Turkey
| | - Bashir A Laway
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India
| | - Hatice S Dokmetas
- Department of Endocrinology, Istanbul Medipol University Medical School, Istanbul, Turkey
| | - Hulusi Atmaca
- Department of Endocrinology, Ondokuz Mayıs University Medical School, Samsun, Turkey
| | - Fahrettin Kelestimur
- Department of Endocrinology, Erciyes University Medical School, 38039, Kayseri, Turkey
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Gokalp D, Alpagat G, Tuzcu A, Bahceci M, Tuzcu S, Yakut F, Yildirim A. Four decades without diagnosis: Sheehan's syndrome, a retrospective analysis. Gynecol Endocrinol 2016; 32:904-907. [PMID: 27252045 DOI: 10.1080/09513590.2016.1190331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AIM Sheehan's syndrome (SS) remains a frequent cause of hypopituitarism in undeveloped and developing countries, but due to improvements in obstetric care, it is rare in developed countries. We aimed to share the results of a retrospective study analyzing the demographic, clinical, imaging, and hormonal characteristics of a large group of patients with SS, and also increase awareness of this syndrome especially in developed countries. METHODS The medical records of 124 patients with SS patients who were followed up in the Endocrinology Department of Dicle University between 1995 and 2015 were assessed retrospectively. RESULTS The mean period of diagnostic delay was 20.37 ± 8.34 years on average. 5.7% of patients with SS were literate; 62% of patients delivered at home. Anemia was identified in 64.5% of SS patients. Mean blood sodium levels were 129.8 ± 11.3 mEq/L. The mean urine densities were 1013 ± 6.5. Osteoporosis and osteopenia were found in 44 (35.4%) and 71 (57.2%) patients, respectively, According to pituitary magnetic resonance imaging (MRI) analyses, 92 (74.2%) patients with SS had completely empty sella, 29 (23.3%) had partially empty sella, and 1 patient had microadenoma, and 2 had normal pituitary MRI results. CONCLUSIONS Improved obstetric care and effective interventions for postpartum hemorrhage have limited the prevalence of SS in developed countries. However, in developing countries like Turkey, SS due to postpartum bleeding remains common. Thus, physician's awareness of the symptoms of SS is urgently required to avoid the associated morbidity and mortality.
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Affiliation(s)
- Deniz Gokalp
- a Department of Endocrinology , Acibadem Medical University , Istanbul , Turkey
| | - Gulistan Alpagat
- b Department of Endocrinology , Dicle University School of Medicine , Diyarbakir , Turkey
| | - Alpaslan Tuzcu
- b Department of Endocrinology , Dicle University School of Medicine , Diyarbakir , Turkey
| | - Mithat Bahceci
- c Izmir Ataturk Education and Research Hospital , Izmir , Turkey
| | - Sadiye Tuzcu
- d Department of Nuclear Medicine , Diyarbakır Gazi Yasargil Education and Research Hospital , Diyarbakir , Turkey
| | - Fatime Yakut
- e Department of Radiology , Diyarbakir Memorial Hospital , Diyarbakir , Turkey , and
| | - Azad Yildirim
- f Department of Orthopedics , Diyarbakır Gazi Yasargil Education and Research Hospital , Diyarbakir , Turkey
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Chihaoui M, Yazidi M, Chaker F, Belouidhnine M, Kanoun F, Lamine F, Ftouhi B, Sahli H, Slimane H. Bone Mineral Density in Sheehan's Syndrome; Prevalence of Low Bone Mass and Associated Factors. J Clin Densitom 2016; 19:413-418. [PMID: 26993664 DOI: 10.1016/j.jocd.2016.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/15/2016] [Accepted: 02/22/2016] [Indexed: 11/16/2022]
Abstract
Hypopituitarism is a known cause of bone mineral loss. This study aimed to evaluate the frequency of osteopenia and osteoporosis in patients with Sheehan's syndrome (SS) and to determine the risk factors. This is a retrospective study of 60 cases of SS that have had a bone mineral density (BMD) measurement. Clinical, biological, and therapeutic data were collected. The parameters of osteodensitometry at the femoral neck and the lumbar spine of 60 patients with SS were compared with those of 60 age-, height-, and weight-matched control women. The mean age at BMD measurement was 49.4 ± 9.9 yr (range: 25-76 yr). The mean duration of SS was 19.3 ± 8.5 yr (range: 3-41 yr). All patients had corticotropin deficiency and were treated with hydrocortisone at a mean daily dose of 26.3 ± 4.1 mg. Fifty-seven patients (95%) had thyrotropin deficiency and were treated with thyroxine at a mean daily dose of 124.3 ± 47.4 µg. Thirty-five of the 49 patients, aged less than 50 yr at diagnosis and having gonadotropin deficiency (71.4%), had estrogen-progesterone substitution. Osteopenia was present in 25 patients (41.7%) and osteoporosis in 21 (35.0%). The BMD was significantly lower in the group with SS than in the control group (p < 0.001). The odds ratio of osteopenia-osteoporosis was 3.1 (95% confidence interval: 1.4-6.8) at the femoral neck and 3.7 (95% confidence interval: 1.7-7.8) at the lumbar spine. The lumbar spine was more frequently affected by low bone mineral mass (p < 0.05). The duration of the disease and the daily dose of hydrocortisone were independently and inversely associated with BMD at the femoral neck. The daily dose of thyroxine was independently and inversely associated with BMD at the lumbar spine. Estrogen-progesterone replacement therapy was not associated with BMD. Low bone mineral mass was very common in patients with SS. The lumbar spine was more frequently affected. The duration of the disease and the doses of hydrocortisone and thyroxine were involved in bone mineral loss.
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Affiliation(s)
- Melika Chihaoui
- Department of Endocrinology, University Hospital La Rabta, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - Meriem Yazidi
- Department of Endocrinology, University Hospital La Rabta, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Fatma Chaker
- Department of Endocrinology, University Hospital La Rabta, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Manel Belouidhnine
- Department of Endocrinology, University Hospital La Rabta, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Faouzi Kanoun
- Department of Endocrinology, University Hospital La Rabta, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Faiza Lamine
- Department of Endocrinology, University Hospital La Rabta, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Bochra Ftouhi
- Department of Endocrinology, University Hospital La Rabta, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Hela Sahli
- Department of Rheumatology, University Hospital La Rabta, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Hedia Slimane
- Department of Endocrinology, University Hospital La Rabta, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
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Abstract
INTRODUCTION The number of studies concerning bone mineral density (BMD) in patients with Sheehan's syndrome (SS) are scarce. We aimed to investigate the relationship between BMD and deficient hormones in patients with newly diagnosed SS. MATERIAL AND METHODS Thirty-four patients with SS and age-gender-weight matched 22 controls were included in the study. RESULTS We found osteoporosis in 61.8%, osteopenia in 32.3%, and normal dual energy X-ray absorptiometry (DEXA) findings in 5.9% patients. In the control group, 68.2% of individuals were osteopenic and 31.8% of them were normal. The number of osteoporotic patients was found to be higher and BMD values were lower in the patient group compared with the control group. There was no relation of DEXA measurements with the period between the last delivery and the initial diagnosis and the estradiol levels. While there was no relation between insulin-like growth factor 1 (IGF-1) and T and Z scores of femur head, the relation between the IGF-1 and L1-L4 T scores was statistically significant. There was a significant relation between the IGF-1 and L1-L4 Z scores. CONCLUSIONS SS patients should also be assessed in terms of osteoporosis at the time of diagnosis and then proper treatment should be initiated afterwards.
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Affiliation(s)
- Fettah Acibucu
- Department of Endocrinology, Sivas Numune Hospital , Sivas , Turkey
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Abstract
Sheehan's syndrome (SS) is characterized by various degrees of hypopituitarism, and develops as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. Increased pituitary volume, small sella size, disseminated intravascular coagulation and autoimmunity are the proposed factors in the pathogenesis of SS. Hormonal insufficiencies, ranging from single pituitary hormone insufficiency to total hypopituitarism, are observed in patients. The first most important issue in the diagnosis is being aware of the syndrome. Lack of lactation and failure of menstrual resumption after delivery that complicated with severe hemorrhage are the most important clues in diagnosing SS. The most frequent endocrine disorders are the deficiencies of growth hormone and prolactin. In patients with typical obstetric history, prolactin response to TRH seems to be the most sensitive screening test in diagnosing SS. Other than typical pituitary deficiency, symptoms such as anemia, pancytopenia, osteoporosis, impairment in cognitive functions and impairment in the quality of life are also present in these patients. Treatment of SS is based on the appropriate replacement of deficient hormones. Growth hormone replacement has been found to have positive effects; however, risk to benefit ratio, side effects and cost of the treatment should be taken into account.
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Affiliation(s)
- Fatih Kilicli
- Department of Endocrinology and Metabolism, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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