Endocrine Abstracts

Introduction: Sheehan syndrome has been for a long time the most frequent cause of hypopituitarism among women in developing countries, including Tunisia. Apart from hormonal deficits caused by SS, young women with SS are exposed to an increased risk of cardiovascular mortality. In this study, we aimed to evaluate the cardiovascular risk in patients with SS. Patients and methods This is a descriptive cross-sectional study. It was carried out in the Endocrinology department of the University Hospital Farhat Hached in Sousse, Tunisia, over a period of nine months, from July 2019 to March 2020. The estimation of the cardiovascular risk was made in patients who had no proven cardiovascular disease at the time of the diagnosis of SS, based on the Framingham score.

Results: Sixty five patients were included to the study. The mean age at diagnosis of SS was 48.2 ± 12.4 years. Thyrotropic and corticotropic insufficiency were present in 86.2% of our patients, followed by gonadotropic and lactotroph insufficiency in 72.3% and 38.5% of patients, respectively. Somatotropic insufficiency was explored by a dynamic test in only 8 patients, concluding with somatotropic deficiency in 10.8% of cases. A cardiovascular accident among first-degree relatives was noted in 10.7% of cases (5 cases of cerebrovascular accidents and 2 cases of myocardial infarction). Four patients had already proven cardiovascular disease at the time of SS diagnosis. The estimation of cardiovascular risk, using the Framingham equation, involved 39 patients. A very low, low or moderate cardiovascular risk was noted in 26.2%, 16.9% and 10.8% of patients, respectively. However a high cardiovascular was noted in 6,2% of patients. Four patients presented with coronary heart disease during follow-up. Three of the four patients, whose cardiovascular risk was considered moderate or high, presented with proven cardiovascular disease during follow-up. Furthermore, none of the patients whose cardiovascular risk was considered very low or low presented with subsequent cardiovascular disease. The difference between the two groups estimated using Fisher’s exact test was statistically significant (P=0.01).

Discussion-Conclusion: Cardiovascular mortality is markedly increased in adults with hypopituitarism, and women are more affected than men. A number of factors contribute to the excess cardiovascular mortality including GH deficiency and untreated gonadotropin deficiency.