Agrawal Mayur, Yadav Subhash C, Singh Swish K, Kumar Sheo, Chatterjee Krishnarpan, Garg Naveen K
Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Indian J Endocrinol Metab. 2024 May-Jun;28(3):260-267. doi: 10.4103/ijem.ijem_297_23. Epub 2024 Jun 26.
Obesity, dyslipidaemia and insulin resistance are associated with hypopituitarism. The association between these conditions and Sheehan's syndrome (SS) caused by post-partum pituitary gland necrosis is poorly understood. This study aimed to assess cardiovascular risk surrogate markers in SS patients, and we compared clinical, biochemical and radiological testing with healthy controls.
In this cross-sectional study, we studied 45 patients with SS on standard replacement therapy and compared them with healthy controls. All subjects underwent anthropometric, inflammatory marker and hormonal measurement (adrenocorticotropic hormone (ACTH), stimulated cortisol, insulin-like growth factor-1 (IGF-1), thyroxine (T4), follicle-stimulating hormone (FSH), luteinising hormone (LH), oestradiol (E2), prolactin (Prl), insulin, interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP)). Carotid intima-media thickness (CIMT), flow-mediated dilation (FMD) and echocardiography were also performed.
The mean age and body mass index (BMI) of SS patients were 48.1 ± 10.0 years and 24.3 ± 4.3 kg/m, respectively, while those of controls were 44.6 ± 12.0 years and 24.6 ± 3.2 kg/m, respectively. Systolic blood pressure was significantly higher in SS (124.6 ± 20.8 vs. 117.0 ± 18.6 mm of Hg, < 0.05). All SS patients were hypothyroid, and all except one were hypocortisolaemic. Triglyceride (TG) levels were significantly higher in SS patients (165.6 ± 83.3 vs. 117.2 ± 56.1, < 0.01), but no difference in the prevalence of metabolic syndrome (MetS) was found. hs-CRP (9.1 (5.2-18.5) vs. 1.5 (0.6-2.8), < 0.001) and IL-6 (4.9 (3.7-7.3) vs. 3.1 (2.0-4.2), < 0.001) were significantly higher in SS patients. CIMT was significantly increased in SS patients, but no difference in FMD was found. Echocardiography revealed no significant difference in left ventricular (LV) dimensions, interventricular thickness, posterior wall thickness, ejection fraction, LV mass and diastolic function.
SS patients show increased cardiovascular risk with hypertension, dyslipidaemia and increased atherosclerotic and inflammatory markers.
肥胖、血脂异常和胰岛素抵抗与垂体功能减退有关。人们对这些病症与产后垂体坏死所致希恩综合征（SS）之间的关联了解甚少。本研究旨在评估SS患者的心血管风险替代标志物，并将临床、生化和影像学检查结果与健康对照者进行比较。
在这项横断面研究中，我们对45例接受标准替代治疗的SS患者进行了研究，并将他们与健康对照者进行比较。所有受试者均接受了人体测量、炎症标志物和激素测量（促肾上腺皮质激素（ACTH）、刺激后的皮质醇、胰岛素样生长因子-1（IGF-1）、甲状腺素（T4）、促卵泡激素（FSH）、促黄体生成素（LH）、雌二醇（E2）、催乳素（Prl）、胰岛素、白细胞介素-6（IL-6）和高敏C反应蛋白（hs-CRP））。还进行了颈动脉内膜中层厚度（CIMT）、血流介导的血管舒张功能（FMD）和超声心动图检查。
SS患者的平均年龄和体重指数（BMI）分别为48.1±10.0岁和24.3±4.3kg/m²，而对照组分别为44.6±12.0岁和24.6±3.2kg/m²。SS患者的收缩压显著更高（124.6±20.8 vs. 117.0±18.6 mmHg，P<0.05）。所有SS患者均存在甲状腺功能减退，除1例外均存在皮质醇水平低下。SS患者的甘油三酯（TG）水平显著更高（165.6±83.3 vs. 117.2±56.1，P<0.01），但代谢综合征（MetS）的患病率无差异。SS患者的hs-CRP（9.1（5.2 - 18.5）vs. 1.5（0.6 - 2.8），P<0.001）和IL-6（4.9（3.7 - 7.3）vs. 3.1（2.0 - 4.2），P<0.001）显著更高。SS患者的CIMT显著增加，但FMD无差异。超声心动图显示左心室（LV）尺寸、室间隔厚度、后壁厚度、射血分数、LV质量和舒张功能无显著差异。
SS患者存在高血压、血脂异常以及动脉粥样硬化和炎症标志物增加，心血管风险升高。
