UNRAVELING THE LINK BETWEEN SHEEHAN’S SYNDROME AND LIVER DYSFUNCTION
Main Article Content
Keywords
Sheehan’s Syndrome, Hypopituitarism, Postpartum Hemorrhage, Endocrine dysfunction, Liver dysfunction, Non-alcoholic steatohepatitis .
Abstract
Background:
Sheehan’s Syndrome (SS) is a rare but serious cause of hypopituitarism in postpartum women, often resulting from ischemic necrosis of the pituitary gland due to severe postpartum hemorrhage. This study aims to evaluate the clinical, biochemical, and hormonal profiles of SS patients and compare them with age- and Body Mass Index (BMI)-matched healthy controls.
Materials and Methods:
A case-control study was conducted with 30 patients diagnosed with Sheehan’s Syndrome and 30 age- and BMI-matched healthy controls. Patients were recruited from the endocrine clinic of Government Medical College, Srinagar, and the diagnosis was established based on clinical history, MRI findings (empty sella), and hormonal deficiencies. Fasting morning blood samples were analyzed for glucose, Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), Thyroid-Stimulating Hormone (TSH), Growth Hormone (GH), Prolactin (PRL), Cortisol, and Free T4 using Immunoradiometric Assay (IRMA). Routine hematological, kidney, and liver function tests were performed. Data were analyzed using SPSS Version 20.0, and a p-value <0.05 was considered statistically significant.
Results:
The mean age of patients and controls was 47.7 ± 4.47 years and 47.3 ± 4.34 years, respectively. The average diagnostic delay was 11.35 ± 4.47 years. BMI analysis revealed that 53.3% of SS patients had normal BMI, 33.3% were overweight, and 13.3% were obese. Hormonal deficiencies were highly prevalent, with GH deficiency in 89.9% of patients, Cortisol deficiency in 84%, PRL deficiency in 72%, LH deficiency in 60%, and FSH deficiency in 40%. Liver function abnormalities were significantly more frequent in SS patients, with 73.3% showing elevated ALT (>40 IU/L, p = 0.009) and 76.7% having elevated ALP (>150 IU/L, p < 0.001). However, bilirubin, AST, and albumin levels did not differ significantly between the two groups.
Conclusion:
Sheehan’s Syndrome is associated with profound pituitary hormone deficiencies and notable liver function abnormalities. In this study observed findings explores a significant association between Sheehan’s Syndrome and metabolic alterations, particularly liver dysfunction, suggesting a potential link between hypopituitarism and non-alcoholic steatohepatitis.
References
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13. Mandal S, Mukhopadhyay P, Banerjee M, Ghosh S. Clinical, Endocrine, Metabolic Profi le, and Bone Health in Sheehan’s Syndrome. Indian J Endocrinol Metab. 2020 Jul-Aug;24(4):338-342.
14. ZELMAN S. The liver in obesity. AMA Arch Intern Med. 1952 Aug;90(2):141-56.
15. Carro E, Señaris R, Considine RV, Casanueva FF, Dieguez C. Regulation of in vivo growth hormone secretion by leptin. Endocrinology. 1997 May;138(5):2203-6.
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17. Bullo M, Garci-Lorda P, Megias I, et al. Systemic infl ammatory, adipose tissue tumor necrosis factor, and leptin expression. Obes Res 2003; 11:525–31.
18. Cohen B, Novick D, Rubinstein M. Modulation of insulin activities by leptin. Science. 1996 Nov 15;274(5290):1185-8.
19. Itoh E, Hizuka N, Fukuda I, Takano K. Metabolic disorders in adult growth hormone defi ciency: A study of 110 patients at a single institute in Japan. Endocr J. 2006 Aug;53(4):539-45.
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21. Ozkan Y, Colak R. Sheehan syndrome: clinical and laboratory evaluation of 20 cases. Neuro Endocrinol Lett. 2005 Jun;26(3):257-60.
22. Nyenwe EA, Williamson-Baddorf S, Waters B, Wan JY, Solomon SS. Nonalcoholic Fatty liver disease and metabolic syndrome in hypopituitary patients. Am J Med Sci. 2009 Sep;338(3):190-5.
23. Hong JW, Kim JY, Kim YE, Lee EJ. Metabolic parameters and nonalcoholic fatty liver disease in hypopituitary men. Horm Metab Res. 2011 Jan;43(1):48-54.
2. Zargar AH, Singh B, Laway BA, Masoodi SR, Wani AI, Bashir MI. Epidemiologic aspects of postpartum pituitary hypofunction (Sheehan’s syndrome).Fertil Steril. 2005 Aug;84(2):523-8.
3. Tanriverdi F, Dokmetas HS, Kebapcı N, Kilicli F, Atmaca H, Yarman S, Ertorer ME, Erturk E, Bayram F, Tugrul A, Culha C, Cakir M, Mert M, Aydin H, Taskale M, Ersoz N, Canturk Z, Anaforoglu I, Ozkaya M, Oruk G, Hekimsoy Z, Kelestimur F, Erbas T. Etiology of hypopituitarism in tertiary care institutions in Turkish population: analysis of 773 patients from Pituitary Study Group database. Endocrine. 2014 Sep;47(1):198-205.
4. Kovacs K. Sheehan syndrome. Lancet. 2003 Feb 8; 361(9356):520-2.
5. Mersebach H, Svendsen OL, Holst JJ, Astrup A, Feldt-Rasmussen U. Comparisons of leptin, incretins and body composition in obese and lean patients with hypopituitarism and healthy individuals. Clin Endocrinol (Oxf). 2003 Jan;58(1):65-71.
6. Jeff coate W. Growth hormone therapy and its relationship to insulin resistance,glucose intolerance and diabetes mellitus: a review of recent evidence. Drug Saf. 2002;25(3):199-212.
7. Holt RI, Simpson HL, Sönksen PH. The role of the growth hormone-insulin like growth factor axis in glucose homeostasis. Diabet Med. 2003 Jan;20(1):3- 15.
8. Rahman TM, Wendon J. Severe hepatic dysfunction in pregnancy. QJM. 2002 Jun;95(6):343-57.
9. Ichikawa T, Hamasaki K, Ishikawa H, Ejima E, Eguchi K, Nakao K. Non alcoholic steatohepatitis and hepatic steatosis in patients with adult onset growth hormone defi ciency. Gut. 2003 Jun;52(6):914.
10. Takahashi Y, Iida K, Takahashi K, Yoshioka S, Fukuoka H, Takeno R, Imanaka M, Nishizawa H, Takahashi M, Seo Y, Hayashi Y, Kondo T, Okimura Y, Kaji H, Kitazawa R, Kitazawa S, Chihara K. Growth hormone reverses nonalcoholic steatohepatitis in a patient with adult growth hormone deficiency. Gastroenterology. 2007 Mar;132(3):938-43.
11. Silveira MG, Mendes FD, Diehl NN, Enders FT, Lindor KD. Thyroid dysfunction in primary biliary cirrhosis, primary sclerosing cholangitis and non-alcoholic fatty liver disease. Liver Int. 2009 Aug;29(7):1094-100.
12. Nishizawa H, Iguchi G, Murawaki A, Fukuoka H, Hayashi Y, Kaji H, Yamamoto M, Suda K, Takahashi M, Seo Y, Yano Y, Kitazawa R, Kitazawa S, Koga M,Okimura Y, Chihara K, Takahashi Y. Nonalcoholic fatty liver disease in adult hypopituitary patients with GH deficiency and the impact of GH replacement therapy. Eur J Endocrinol. 2012 Jul;167(1):67-74.
13. Mandal S, Mukhopadhyay P, Banerjee M, Ghosh S. Clinical, Endocrine, Metabolic Profi le, and Bone Health in Sheehan’s Syndrome. Indian J Endocrinol Metab. 2020 Jul-Aug;24(4):338-342.
14. ZELMAN S. The liver in obesity. AMA Arch Intern Med. 1952 Aug;90(2):141-56.
15. Carro E, Señaris R, Considine RV, Casanueva FF, Dieguez C. Regulation of in vivo growth hormone secretion by leptin. Endocrinology. 1997 May;138(5):2203-6.
16. Sainsbury A, Cooney GJ, Herzog H. Hypothalamic regulation of energy homeostasis. Best Pract Res Clin Endocrinol Metab. 2002 Dec;16(4):623-37.
17. Bullo M, Garci-Lorda P, Megias I, et al. Systemic infl ammatory, adipose tissue tumor necrosis factor, and leptin expression. Obes Res 2003; 11:525–31.
18. Cohen B, Novick D, Rubinstein M. Modulation of insulin activities by leptin. Science. 1996 Nov 15;274(5290):1185-8.
19. Itoh E, Hizuka N, Fukuda I, Takano K. Metabolic disorders in adult growth hormone defi ciency: A study of 110 patients at a single institute in Japan. Endocr J. 2006 Aug;53(4):539-45.
20. Rufi natscha K, Ress C, Folie S, Haas S, Salzmann K, Moser P, Dobner J, Weiss G, Iruzubieta P, Arias-Loste MT, Crespo J, Tilg H, Kaser S. Metabolic eff ects of reduced growth hormone action in fatty liver disease. Hepatol Int. 2018 Sep;12(5):474-481.
21. Ozkan Y, Colak R. Sheehan syndrome: clinical and laboratory evaluation of 20 cases. Neuro Endocrinol Lett. 2005 Jun;26(3):257-60.
22. Nyenwe EA, Williamson-Baddorf S, Waters B, Wan JY, Solomon SS. Nonalcoholic Fatty liver disease and metabolic syndrome in hypopituitary patients. Am J Med Sci. 2009 Sep;338(3):190-5.
23. Hong JW, Kim JY, Kim YE, Lee EJ. Metabolic parameters and nonalcoholic fatty liver disease in hypopituitary men. Horm Metab Res. 2011 Jan;43(1):48-54.
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Published
Oct 17, 2025
Article Details
How to Cite
Rameez Raja Najar, Mir shahnaz, & Pulkit Sondhi. (2025). UNRAVELING THE LINK BETWEEN SHEEHAN’S SYNDROME AND LIVER DYSFUNCTION. Journal of Population Therapeutics and Clinical Pharmacology, 32(9), 791-796. https://doi.org/10.53555/s3462k62
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Author Biographies
Rameez Raja Najar
Government Medical College, Srinagar
Mir shahnaz
Government Medical College, Srinagar
Pulkit Sondhi
BLK Max SS Hospital New delhi
How to Cite
Rameez Raja Najar, Mir shahnaz, & Pulkit Sondhi. (2025). UNRAVELING THE LINK BETWEEN SHEEHAN’S SYNDROME AND LIVER DYSFUNCTION. Journal of Population Therapeutics and Clinical Pharmacology, 32(9), 791-796. https://doi.org/10.53555/s3462k62