Department of Internal Medicine and Endocrinology, Government Medical College, Srinagar, Jammu and Kashmir, India.
Department of Biochemistry/Clinical Biochemistry, University of Kashmir, Srinagar, Jammu and Kashmir, India.
Pituitary. 2022 Feb;25(1):92-99. doi: 10.1007/s11102-021-01174-z. Epub 2021 Jul 30.
Sheehan's Syndrome (SS) is one of the most important causes of hypopituitarism in developing countries with patients having varying degrees and severity of anterior pituitary hormone deficiency including growth hormone deficiency (GHD). SS is characterized by increased clustering of metabolic and proinflammatory risk factors predisposing them to increased cardiovascular morbidity and mortality. Coronary calcium deposits (CCD), a marker for significant coronary atherosclerosis, is used for evaluation in asymptomatic individuals of global cardiac risk to develop events related to coronary heart disease (CHD). This study therefore aimed to evaluate the prevalence of coronary artery disease in patients with SS appropriately replaced for pituitary hormone deficiencies but untreated for GHD.
Thirty patients previously diagnosed with SS and stable on a conventional replacement treatment for at least 6 months before the study and thirty age and Body Mass Index (BMI) matched controls were enrolled in this observational study. The subjects underwent detailed clinical, biochemical, and hormone analysis. Coronary multidetector computed tomography was performed in 19 SS patients and 19 healthy participants by a 16-row multislice scanner. Non contrast acquisitions were performed to detect coronary calcifications. Calcium was quantified by the Agatston score (AS) in all subjects. AS > 10 indicates increased CHD risk.
The mean (± SD) age was 38.30 ± 10.73 years and the diagnostic delay was 11.35 ± 4.74 years. Patients with SS had significantly higher mean triglyceride, total cholesterol, and low density lipoprotein (LDL) cholesterol and lower HDL cholesterol concentrations on conventional replacement therapy. The prevalence of CCD was significantly higher in patients of SS compared to controls (42.1% vs. 5.3%; P = 0.023). The presence of CCD and AS > 10 were detected in 42.1% and 31.6% of patients respectively. The presence of significant calcification (Agatston score > 10) was documented in 75% of patients (6/8) of the SS patients with CCD compared to none in the control group (P = 0.019). (Left anteriordescending, 1; left circumflex, 2; right coronary artery, 2 and posterior descending, 1) CONCLUSION: Since coronary artery calcium is an independent predictor of CHD events, the presence of significant prevalence of CCD in patients with SS compared to healthy matched controls, undermines the importance of early risk stratification of SS individuals with plethora of conventional cardiovascular risk factors that are at relatively high risk to avoid the adverse vascular consequences.
希恩氏综合征（SS）是发展中国家导致垂体功能减退症的最重要原因之一，患者存在不同程度和严重程度的前垂体激素缺乏症，包括生长激素缺乏症（GHD）。SS 的特征是代谢和促炎危险因素的聚集增加，使他们更容易发生心血管发病率和死亡率增加。冠状动脉钙沉积（CCD）是冠状动脉粥样硬化的一个重要标志物，用于评估无症状个体的全球心脏风险，以发现与冠心病（CHD）相关的事件。因此，本研究旨在评估适当替代垂体激素缺乏症但未治疗 GHD 的 SS 患者的冠状动脉疾病患病率。
本观察性研究纳入了 30 名先前被诊断为 SS 并在研究前至少接受了 6 个月常规替代治疗的患者和 30 名年龄和体重指数（BMI）匹配的对照组。对受试者进行了详细的临床、生化和激素分析。通过 16 层多层螺旋 CT 扫描仪对 19 名 SS 患者和 19 名健康参与者进行了冠状动脉多排 CT 检查。进行非对比采集以检测冠状动脉钙化。所有受试者均采用 Agatston 评分（AS）定量钙。AS＞10 表示 CHD 风险增加。
平均（±标准差）年龄为 38.30±10.73 岁，诊断延迟为 11.35±4.74 年。SS 患者在接受常规替代治疗时，甘油三酯、总胆固醇和低密度脂蛋白（LDL）胆固醇的平均浓度明显较高，而高密度脂蛋白（HDL）胆固醇浓度较低。与对照组相比，SS 患者的 CCD 患病率明显更高（42.1%比 5.3%；P=0.023）。SS 患者中存在 CCD 和 AS＞10 的比例分别为 42.1%和 31.6%。在 8 名有 CCD 的 SS 患者中，有 75%（6/8）存在明显钙化（Agatston 评分＞10），而对照组无一例（P=0.019）。（左前降支 1 支，左回旋支 2 支，右冠状动脉 2 支，后降支 1 支）结论：由于冠状动脉钙是 CHD 事件的独立预测因子，因此与健康对照组相比，SS 患者存在大量的常规心血管危险因素，且 CCD 的患病率较高，这凸显了对 SS 个体进行早期风险分层的重要性，这些个体处于相对较高的风险中，以避免不良的血管后果。
