Background:
Sheehan's syndrome (SS) occurs due to ischemic pituitary necrosis resulting from severe postpartum hemorrhage (PPH). SS is characterized by varying degrees of pituitary insufficiency involving mostly the anterior lobe. Comprehensive data on SS apart from endocrine dysfunction is scarcely available.
Materials and Methods:
Thirty-eight subjects previously diagnosed with SS were enrolled in this observational study. Their clinical, biochemical, hormonal, radiological data at presentation were recorded from past records and bone density was measured in all.
Results:
Mean (±SD) age was 39 (±8.7) years and diagnostic delay was 9.3 (±5.5) years. All had history of PPH and lactation failure. About 47% were referred from emergency, and rest 53% were diagnosed from outpatient's department. Mean free T4, TSH, prolactin, morning cortisol, FSH, LH, and IGF-1 were mostly low. Panhypopituitarism was present in 97%. Hyponatremia was most common electrolyte imbalance found in about 53%. More than 40% had elevated transaminases. Dyslipidemia especially low HDL was found in 31 (81.5%) subjects. MRI of hypothalamus–pituitary region showed empty sella in 53% and partial empty sella in 47%. About 13% subjects had diabetes mellitus. Low bone mass (BMD Z-Score ≤-1) was seen in 80% and it was more severe (BMD Z-Score ≤-2) in 44% subjects, affecting predominantly lumbar spine. Bone loss at femoral neck was less prominent.
Conclusion:
Apart from variable spectrum of clinical presentation, subjects with SS have significant abnormalities in serum electrolytes, metabolic parameters. Low bone mass is also a frequent accompaniment.
Background
Majority of women with Sheehan syndrome (SS) suffer from sexual dysfunction. Severe androgen deficiency is a major contributory factor. DHEA supplementation has been reported to have variable efficacious in improving female sexual dysfunction (FSD) in several trials. Studies using DHEA in SS are not available.
Materials and Methods
Twenty-eight patients (age 39.7 ±8.6 years) with SS divided in two groups using block randomization technique, received DHEA supplements (25mg twice daily) or matched placebo sequentially for 3 months each in this cross-over trial. FSFI score and serum DHEAS were measured at baseline and after completion of each phase. Glycemic parameters, lipid profile, liver enzymes were also measured to assess metabolic side effects.
Results
There was significant improvement in FSFI score from baseline to end of the study in the DHEA group as compared to the placebo group (p=0.006). Mean FSFI score and most of the individual domains of FSD improved with DHEA significantly in both groups (p=0.001 for each group with DHEA). Those who received DHEA first followed by placebo, FSFI declined significantly after placebo (p=0.041), but remained at an acceptable level of sexual functioning. Serum DHEAS increased significantly with DHEA treatment. No significant changes in glycemic index, lipid profile and liver enzymes were noted with DHEA treatment.
Conclusion
Short duration of DHEA supplementation in women with SS with FSD is efficacious and safe.
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