Bone Mineral Density in Sheehan's Syndrome; Prevalence of Low Bone Mass and Associated Factors

Chihaoui, Mélika; Yazidi, Mériem; Chaker, Fatma; Belouidhnine, Manel; Kanoun, F.; Lamine, Faïza; Ftouhi, B.; Sahli, H.; Slimane, H.

doi:10.1016/j.jocd.2016.02.002

Cited by 10 publications

(5 citation statements)

References 22 publications

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“…However, the lumbar spine was more frequently affected by low bone mineral mass in a study by Chihaoui M et al . [ 19 ] This is in contrast to the study by Agarwal et al ., who have demonstrated that subjects with SS had significantly lower BMD compared to controls at all three sites. [ 20 ] Significant osteoporosis (T-score ≤-2.5 in L1–L4 spine) was present in about 42% subjects.…”

Section: Discussioncontrasting

confidence: 66%

Clinical, endocrine, metabolic profile, and bone health in Sheehan's syndrome

Mandal

Mukhopadhyay

Banerjee

et al. 2020

Indian J Endocr Metab

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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.

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Section: Discussioncontrasting

confidence: 66%

Clinical, endocrine, metabolic profile, and bone health in Sheehan's syndrome

Mandal

Mukhopadhyay

Banerjee

et al. 2020

Indian J Endocr Metab

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“…It is noteworthy that in our research there was no adequate replacement of the gonadal axis nor of the somatotropic axis by previously reported factors, being patients that due to delayed diagnosis was submitted to many years of hypoestrogenism. Chihaoui et al ( 26 ) in a study of 60 patients diagnosed with SS concluded that reduced bone mineral density was a finding frequently observed in such individuals. Such result inserted in the context of the present study is important because of the existence of an association between low bone mineral density and tooth loss and maxillomandibular alveolar bone loss ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Dental status, salivary flow, and sociodemographic aspects in Sheehan Syndrome patients

Cavalcante

Pinto-Quidute²,

Alves-Martins³

et al. 2018

Med Oral

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BackgroundSheehan’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 MethodsA cross-sectional study was performed with 23 women diagnosed with SS at the Division of Endocrinology and Diabetes (Walter Cantídio University Hospital, Fortaleza, Brazil).ResultsData 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.ConclusionsIn 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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“…To date, there are no published studies that evaluated the fractal dimension in SSH, which may reflect the altered bone metabolism in this disease due to pituitary failure. 45 In SSH, progressive loss of pituitary gland function decreases the secretion of hormones such as growth hormone (GH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (T3 and T4), adrenocorticotrophic hormone (ACTH), cortisol, estradiol, and prolactin. Such hormones may alter the trabecular bone pattern, which may cause osteopenia as well as osteoporosis.…”

Section: Discussionmentioning

confidence: 99%

“…However, scarce data has been addressed to the literature, since only 4 studies provided data of bone mass in women affected by this endocrine disease compared with control individuals. 5,12,45,47 Agarwal et al 12 obtain data about the bone mineral density of the patients, which has been considered a determinant aspect to provide bone strength. 48 However, it was performed in the present study, for the first time in SSH, a mandibular fractal analysis aiming to provide a suitable statistical texture analysis, which reflects the bone texture roughness and grey-level variations.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of bone texture imaging parameters on panoramic radiographs of patients with Sheehan’s syndrome: a STROBE-compliant case-control study

Cavalcante

Castro²,

Quidute

et al. 2019

Osteoporos Int

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Objectives: Sheehan's syndrome (SSH) is an important public health problem characterized as postpartum hypopituitarism secondary to obstetric complications-related ischemic pituitary necrosis that shows significant systemic metabolic repercussion. Thus, this study aimed to evaluate texture parameters in digital panoramic radiographs of patients with SSH. Methods: A case-control study was conducted with 30 SSH patients from an Endocrinology and Diabetology Service of reference in Brazil, and 30 age-and sexmatched healthy controls. A custom computer program measured fractal dimension, lacunarity and some morphologic features in the following mandibular regions of interest (50x50 pixels): below the mental foramen (F1), between the first and second molars (M1), and 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 SSH group, as well as lacunarity in R1 (p = 0.008). Additionally, several morphologic features were statistically significant in the SSH group (p < 0.05). Conclusion: Therefore, individuals with SSH 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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Bone Mineral Density in Sheehan's Syndrome; Prevalence of Low Bone Mass and Associated Factors

Cited by 10 publications

References 22 publications

Clinical, endocrine, metabolic profile, and bone health in Sheehan's syndrome

Clinical, endocrine, metabolic profile, and bone health in Sheehan's syndrome

Dental status, salivary flow, and sociodemographic aspects in Sheehan Syndrome patients

Evaluation of bone texture imaging parameters on panoramic radiographs of patients with Sheehan’s syndrome: a STROBE-compliant case-control study

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