Preservation of thyrotroph function in Sheehan's syndrome

Laway, Bashir Ahmad; Sumji, Sajad

doi:10.4103/ijem.ijem_346_17

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“…[ 6 ] Somatotroph and thyrotroph cells are involved in all cases of SS, and preservation or recovery of gonadotroph, lactotroph, or corticotroph cells is reported in a few such patients. [ 7 8 9 10 ] Because of the advantageous blood supply, posterior pituitary involvement is less common,[ 2 10 ] even though histological examination many years after the initial insult reveals some scarring and atrophy of the posterior pituitary as well. [ 11 ] Central diabetes insipidus (CDI), either partial or complete, is reported in 5% of patients with SS when assessed by water deprivation test (WDT).…”

Section: Introductionmentioning

confidence: 99%

Anterior and Posterior Pituitary Function in Patients with Sheehan Syndrome – Combining the use of Insulin Tolerance Test and Copeptin Assay

Laway,

Bansiwal,

Baba

et al. 2024

Indian Journal of Endocrinology and Metabolism

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Introduction: Sheehan syndrome (SS) typically involves the loss of anterior pituitary cells and rarely affects the posterior pituitary. The water deprivation test (WDT) is the gold standard for diagnosing central diabetes insipidus (CDI), but it is cumbersome. Serum copeptin measurements are an alternative for CDI diagnosis. In this study, we measured hypoglycaemia-stimulated serum copeptin in SS patients to assess posterior pituitary function alongside anterior pituitary hormone levels. Methods: This study recruited 43 patients with SS on stable hormonal replacement except for growth hormone (GH), 18 patients with CDI, and 19 body mass index (BMI) and parity-matched controls. All patients with SS and four patients with CDI underwent an insulin tolerance test (ITT), and hypoglycaemia-stimulated copeptin levels were measured at 0, 30, 45, and 90 minutes after insulin injection. Results: The mean serum copeptin level among patients with SS (26.01 ± 12.41 pmol/L) was significantly lower than that in healthy controls (31.92 ± 7.85 pmol/L) and higher than that in patients with CDI (1.81 ± 0.14 pmol/L). Using pre-defined cut-offs for CDI, basal serum copeptin <2.69 pmol/L and stimulated levels <4.92 pmol/L for complete central DI, and basal copeptin levels >2.69 pmol/L and stimulated copeptin <4.92 pmol/L for partial central DI, 9.2% (n = 4) of patients with SS had CDI, of which half had complete CDI and half had partial CDI. Conclusion: A significant number of patients with SS who are on hormone replacement therapy show involvement of the posterior pituitary, despite not displaying symptoms.

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