Two years of growth hormone replacement therapy in a group of patients with Sheehan’s syndrome

Abstract

To investigate the effects of GH replacement on lipid profile, carotid artery intima-media thickness (IMT), glucose metabolism and visceral fat in patients with Sheehan's syndrome, ten patients, mean age 44.8+/-9.5 yr, compared with 10 controls matched for age and body mass index were studied. Total cholesterol, Triglycerides (TG), HDL-c, LDL-c, Apolipoprotein A and B (apoA and apoB) and Lipoprotein (a), serum IGF-1, ultrasonography of the carotid arteries, oral glucose tolerance test (OGTT), HOMA insulin resistance index, insulin sensitivity index (ISI)-composite and abdominal CT scan were performed. When compared to a control group, patients presented lower HDL concentrations (p=0.05) and 2-h OGTT insulin levels (p<0.04) and increased TG levels (p<0.04). After 24 months of GH replacement a reduction in the relation ApoB/ApoA (p=0.04) was observed, as well as an increase in HDL (p<0.004). A decrease in carotid artery IMT and in visceral fat over time was found, p<0.03 and p<0.04 respectively, though without any significant differences during post hoc comparisons of means, which may be explained by the small number of cases studied, but there was a tendency, p=0.08 and p=0.09 respectively. The 2-h OGTT insulin levels increased (p<0.02) as well as the prevalence of glucose intolerance (prevalence = 42.8%, p<0.05). GH replacement therapy promoted favorable effects on carotid artery IMT, lipid profile and visceral fat in patients with Sheehan's syndrome. On the other hand, patients developed abnormal glucose tolerance probably due to an increase in insulin resistance, demonstrated by higher insulin levels, despite favorable changes in body composition.

Aspectos diagnósticos e terapêuticos da síndrome de Sheehan

“…Há relatos de pacientes que evoluíram com hiponatremia aguda e sín-drome de secreção inapropriada de hormônio antidiurético (ADH) 10 dias após o parto (16) e outras que tiveram seu diagnóstico somente 33 anos após o nascimento do último filho (17). Em nossa série, as pacientes apresentavam sintomas crônicos de hipopituitarismo, algumas com diagnóstico no primeiro ano após o parto e outras mais de 20 anos após o parto (10).…”

“…A extensão da disfunção hipofisária varia nas diversas séries (10,(17)(18)(19)(20)(21)(22), visto que na maioria dos estudos o principal acometimento foi o da secreção de prolactina e GH (90% a 100%), enquanto as deficiências na secreção de cortisol, TSH e gonadotrofinas variaram de 50% a 100%. A deficiência de GH é muito comum na síndrome de Sheehan, desde que os somatotrófos estejam localizados nas regiões inferiores e laterais da hipó-fise, sendo bastante suscetíveis à isquemia (23).…”

“…Em nosso serviço avaliamos 10 pacientes com sín-drome de Sheehan antes e após a reposição com GH recombinante (10). Além da deficiência de GH, todas eram deficientes de ACTH, TSH, LH, FSH e prolactina e estavam repostas com prednisona, levotiroxina e estrogênio e acetato de medroxiprogesterona.…”

“…Esta revisão tem por objetivo descrever aspectos clínicos, laboratoriais e terapêuticos da síndrome de Sheehan, incluindo a nossa experiência pessoal na reposição com GH recombinante neste grupo de pacientes (10).…”

Clinical, hormonal and radiological features of partial Sheehan’s syndrome: an Indian experience

“…Sheehan's syndrome (SS) is the most common cause of hypopituitarism in women from developing countries (2). Improvement in the ob stetric care has considerably decreased the prevalence of SS in western world (3). An epidemiological study from India (Kashmir) has documented a prevalence of around 3.1% in adult women (4).…”