Effects of Hypopituitarism Due to Sheehan's Syndrome on Bone Mineral Density: A Multicentric Study in Asian Indians

Sheehan's syndrome (SS) is a rare cause of hypopituitarism. Data on skeletal health in patients with this condition is limited and predictors of low bone mineral density (BMD) are not well elucidated. We aimed to explore hormonal profile and BMD in a large multicentric cohort of treated SS patients.

The study recruited patients with SS on stable hormone replacement (n = 110) and healthy female controls (n = 102). The hormonal profile (cortisol, DHEAS, T4, TSH, prolactin, IGF1) was analyzed. Bone turnover markers (P1NP, β-CTX) were estimated by electrochemiluminescence assay. BMD was evaluated using DXA. Prevalence and predictors of low BMD were assessed.

The cohort comprised 110 patients with SS with a mean age of 45.3 ± 10.5 years and a delay of 7.9 ± 6.3 years from disease onset to diagnosis. Patients were on glucocorticoid (94.6%) and levothyroxine (90.5%) replacement, with prior exposure to estrogen-progestin (66.7%). Bone turnover markers were not significantly different between the two groups. Low BMD (osteopenia/osteoporosis) was prevalent in a significantly greater proportion of the cases as compared to controls at the lumbar spine (94% vs 47%) and femoral neck (80% vs 36%). The most important predictor of low BMD at the lumbar spine was the length of delay prior to diagnosis (OR 1.48 (95% CI 1.002-2.206), p = 0.04).

SS is characterized by a high prevalence of multiple pituitary hormone deficiencies, including hypoprolactinaemia. Low BMD is highly prevalent in SS compared to age, and BMI-matched controls. Despite adequate relevant hormone replacement therapy, a longer delay in diagnosing is the major determinant of low BMD in patients with SS.