Sheehan’s syndrome in GH-naive women may increase CV risk
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SAN DIEGO — Women with Sheehan’s syndrome and growth hormone deficiency have higher total cholesterol and triglycerides and higher inflammatory markers compared with healthy adults, according to a speaker.
Sheehan’s syndrome is a postpartum hypopituitarism caused by ischemic necrosis of the pituitary gland after extreme hypotension or shock following severe hemorrhaging at childbirth, according to Rajaram Karne, MD, a clinical endocrinologist at the Veterans Affairs Medical Center in Columbus, Ohio. Severe GH deficiency is a common feature in women with Sheehan’s syndrome, and previous evidence suggest Sheehan’s syndrome and GH deficiency may be associated with adverse cardiovascular risk factors.
“These patients with Sheehan’s syndrome have an abnormal lipid profile, raised inflammatory markers and raised carotid intima-media thickness,” Karne said during a presentation. “These patients constitute a group where there is a risk for worse cardiovascular disease and increased risk for vascular events, even though they are asymptomatic up to this point.”
Researchers conducted an observational cross-sectional study at Government Medical College in Srinagar, India. A cohort of 37 GH-naive women with Sheehan’s syndrome whose condition was stable with conventional replacement therapy for at least 6 months were matched with women without Sheehan’s syndrome. Clinical, anthropometric and biochemical parameters were collected for all participants. A carotid intima-media thickness assessment was conducted through use of a high-resolution echo-color Doppler system.
“The objective of this study was to determine the level of conventional CV risk factors, markers of inflammation and carotid artery intima-media thickness in women with Sheehan’s syndrome, and compared that with the non-Sheehan’s syndrome population,” Karne said.
Women with Sheehan’s syndrome had higher mean total cholesterol (188 mg/dL vs. 148 mg/dL), higher triglycerides (216 mg/dL vs. 154 mg/dL), lower HDL cholesterol (46 mg/dL vs. 61 mg/dL) and higher LDL cholesterol (112 mg/dL vs. 75 mg/dL; P < .001 for all) compared with controls. The Sheehan’s syndrome group had higher levels of the inflammatory markers tumor necrosis factor-alpha (P = .041) and interlukin-6 (P = .004) compared with the control group. Carotid artery intima-media thickness was also higher in women with Sheehan’s syndrome compared with controls (0.71 mm vs. 0.59 mm; P = .001).
“Even today, Sheehan’s syndrome is the most common cause of adult growth hormone deficiency in our part of the world,” Karne said. “These women are adversely at risk for CV risk factors. This contribution comes through in elevated inflammatory markers and intima-media thickness.”
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Karne R et al. Endothelial dysfunction and increased carotid intima-media thickness in the cardiovascularly asymptomatic growth hormone naive patients of Sheehan’s syndrome. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; May 12-14, 2022; San Diego.
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