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Long-term hepatic and cardiac health in patients diagnosed with Sheehan’s syndrome

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Abstract

Purpose

Sheehan’s syndrome (SS) is characterised by chronic pituitary insufficiency following a vascular insult to the pituitary in the peripartum period. There is a lack of substantial evidence on the long-term hepatic and cardiac consequences in these patients, following hormone replacement.

Methods

Patients with a diagnosis of SS were recruited for the study. Detailed clinico-biochemical and radiological evaluation were performed in all patients (n = 60). Hepatic and cardiac complications were assessed using fibroscan and echocardiography (2D speckle-tracking) respectively, in a subset of patients (n = 29) as well as age-and BMI-matched controls (n = 26). Controlled attenuation parameter (for steatosis) and liver stiffness measurement (for fibrosis) were used to define non-alcoholic fatty liver disease (NAFLD). Diastolic cardiac function was evaluated using standard criteria and systolic function by ejection fraction and global longitudinal strain (GLS).

Results

The mean age of the cohort was 42.7 ± 11.6 years. Multiple (≥ 2) hormone deficiencies were present in 68.8% of patients, with hypothyroidism (91.4%), hypocortisolism (88.3%), and growth hormone (GH) deficiency (85.7%) being the most common. At a mean follow-up of 9.8 ± 6.8 years, NAFLD was present in 63% of patients, with 51% having severe steatosis, which was predicted by the presence of GH deficiency and higher body mass index. Though the ejection fraction was similar, increased left ventricular GLS (18.8 vs. 7.7%) was present in a significantly higher number of patients versus controls.

Conclusion

NAFLD, especially severe hepatic steatosis, is highly prevalent in SS. Subclinical cardiac systolic dysfunction (impaired GLS) is also more common, but of mild intensity.

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Funding

No funding was received for conducting this study.

Author information

Author notes

  1. Liza Das and Jayaprakash Sahoo are joint first authors.

Authors and Affiliations

  1. Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Nehru Extension Block, Chandigarh, 160012, India

    Liza Das, Sanjay Kumar Bhadada & Pinaki Dutta

  2. Department of Endocrinology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India

    Jayaprakash Sahoo

  3. Department of Cardiology, PGIMER, Chandigarh, India

    Neelam Dahiya

  4. Department of Hepatology, PGIMER, Chandigarh, India

    Sunil Taneja

  5. Department of Internal Medicine and Endocrinology, Government Medical College, Srinagar, India

    Mohammad Hayat Bhat

  6. Department of Radiology, PGIMER, Chandigarh, India

    Paramjeet Singh

  7. Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India

    Vanita Suri

  8. Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, India

    Bashir Ahmad Laway

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  1. Liza Das
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Contributions

LD was involved in patient management and follow-up, data curation analysis and interpretation, and drafting the manuscript. JP was involved in patient follow-up, data compilation and editing the manuscript. ND was the expert cardiologist who performed the echocardiography and edited the manuscript. ST was the expert hepatologist who performed the transient elastography and edited the manuscript. SKB supervised patient management and edited the manuscript. MHB was involved in patient management and follow-up. PS provided neuroradiological expertise. VS was involved in patient management. BAL supervised patient management and edited the manuscript. PD conceptualized the idea, supervised patient management and follow-up, and edited the manuscript. All authors have read and approved the final version of the manuscript.

Corresponding authors

Correspondence to Bashir Ahmad Laway or Pinaki Dutta.

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Das, L., Sahoo, J., Dahiya, N. et al. Long-term hepatic and cardiac health in patients diagnosed with Sheehan’s syndrome. Pituitary 25, 971–981 (2022). https://doi.org/10.1007/s11102-022-01282-4

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