Endocrine Abstracts

Background: Sheehan’s syndrome or postpartum pituitary necrosis though rare, is still remains one of the commonest causes of hypopituitarism in the developing parts of world like Indian subcontinent. The clinical presentation is often variable and frequently accompanied by hypogonadism which leads to low bone density due to loss of bone protective effect of oestrogen.

Aims: To find out the bone mineral density and the quality of life (QoL) in patients of Sheehan’s syndrome, and to find out the effect of hormonal replacement therapy on outcome.

Material and methods: All patients previously diagnosed as Sheehan’s syndrome or newly admitted during the study period of 3 years were enrolled in the study after obtaining an informed consent. Their clinical, biochemical, hormonal, radiological, and bone mineral density (BMD) data were collected. QoL was assessed using the disease-specific QoL both before and after hormone replacement therapy.

Results: Twenty-three patients were enrolled in the study, the mean age of diagnosis was 43.4±14.2 years; mean diagnostic delay was 13.2±7.4 years. Secondary amenorrhoea and lactation failure were the most common clinical presentations. The bone mineral characteristic of patients with Sheehan’s syndrome, revels T-score, were found to be significantly reduced in lumbar spine (−2.8±0.6) and femoral neck (−2.9±0.8) as also Z-score; these are −1.6±0.6 and −1.4±0.6 respectively. Severe osteoporosis (osteoporosis with fracture) was found in three patients (13%), osteoporosis in four patients (17.3%), osteopenia in six patients (26%), and rest ten patients had normal BMD. The QoL of patients with Sheehan’s syndrome before and after hormonal replacement therapy for 1 year, before start of therapy the score was 25±8 and it increased to 59.4±8.6 after 1 year of hormonal replacement therapy.

Conclusion: Sheehan’s syndrome resulted in multiple pituitary hormone deficiencies in all the patients. Low bone mass and low QoL were frequently seen in patients with Sheehan’s syndrome. Both low mineral density (P<0.05) and QoL improved significantly (P<0.05) after hormonal replacement therapy.