Clinical Characteristics, and Prevalence of Hepatic and Bone Mineral Density Abnormalities in Patients With Sheehan Syndrome: Data From a Tertiary Care Center

Abstract

Objective

Sheehan syndrome (SS), or postpartum pituitary necrosis, occurs due to reduced vascular supply to pituitary gland after postpartum hemorrhage, often linked to coagulation abnormalities, and pituitary antibodies. A smaller sella turcica volume is a risk factor for SS, consequent to compressive effects on the pituitary stalk. Hypopituitarism in SS increases the risk of metabolic liver and bone diseases. This study aimed to assess the clinical profile of SS, estimate sella turcica volume, and quantify liver fat and bone mineral density.

Methods

This case-control study recruited 50 patients with SS and an equal number of healthy controls.

Results

The mean age (52.14 ± 8.47 vs 51.20 ± 7.46 years, P = .55) and body mass index (23.33 ± 3.61 vs 23.46 ± 3.10 kg/m², P = .86) were similar between patients with SS and controls. Lactational failure occurred in 88%, and 96% had secondary amenorrhea. Overall, 94% of patients had growth hormone deficiency, 96% had hypogonadism, 96% had thyrotroph failure, and 92% had corticotroph failure. Sella turcica volume was lower in patients with SS than in controls (350.90 ± 109.05 mm³ vs 565.47 ± 85.15 mm³, P ≤ .01) but there was no correlation with age, body mass index, childbirth duration, insulin-like growth factor 1, or number of pituitary hormone deficiencies. The distribution of hepatic steatosis was mild in 4%, moderate in 8% and severe in 12%. The results indicate that 10% of patients had mild fibrosis, 4% had moderate fibrosis, and none had severe fibrosis. Osteopenia was present in 30% of patients and osteoporosis in 60% of patients.

Conclusion

Patients with SS had a lower sella turcica volume than controls. Additionally, 90% of patients had osteoporosis or osteopenia, and many also had hepatic steatosis or fibrosis.