title: Insulin resistance, metabolic syndrome and chronic low grade inflammation in Sheehan's syndrome on standard replacement therapy: a case control study.
abstract: BACKGROUND
  Increased clustering of metabolic risk factors has been demonstrated in patients with hypopituitarism on standard replacement therapy. This usually has been attributed to persistent growth hormone deficiency, though contribution from underlying etiology of hypopituitarism cannot be underestimated. We, therefore, studied conventional metabolic risk factors and pro inflammatory markers in a cohort of hypopituitary patients in whom the etiology was Sheehan's syndrome.
  
  
  METHODS
  We studied 30 GH naive patients with Sheehan's syndrome (SS) on standard replacement therapy and compared with healthy age, BMI and parity matched controls. All subjects were normotensive, non-diabetic, non-smokers and none had history of any acute or chronic illness. We recorded height, weight, BMI, waist circumference and waist hip ratio, besides measuring biochemical parameters like lipid profile, fasting plasma glucose and insulin, sVCAM-1, ICAM-1 and hsCRP.
  
  
  RESULTS
  Metabolic syndrome and impaired glucose tolerance were more common with SS patients. Similarly total cholesterol (mean ± SD, 5.21 ± 0.98 vs 4.57 ± 0.88, P = 0.00), LDL-cholesterol (3.15 ± 0.90 vs 2.67 ± 0.75, P = 0.02), triglycerides (2.14 ± 1.00 vs 1.43 ± 0.45, P = 0.00) and pro-inflammatory markers i.e. hsCRP (3.95 ± 2.58 vs 1.45 ± 2.77, P = 0.00) were significantly higher in patients with SS. hsCRP positively correlated with fasting insulin (r = 0.40, P = 0.02), HOMA-IR (r = 0.38, P = 0.03) and negatively with HDL (r = - 0.33, P = 0.05).
  
  
  CONCLUSIONS
  GH naïve SS patients on standard replacement therapy have increased clustering of metabolic and pro-inflammatory risk factors.
authors.affiliation: Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.
authors.forename: Manzoor Ahmad
authors.initials: MA
authors.lastname: Bhat
authors.forename: Bashir Ahmad
authors.initials: BA
authors.lastname: Laway
authors.forename: Zaffar Amin
authors.initials: ZA
authors.lastname: Shah
authors.forename: Arshad Iqbal
authors.initials: AI
authors.lastname: Wani
authors.forename: Idrees
authors.initials: I
authors.lastname: Mubarik
mesh_terms: D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D016022:Case-Control Studies; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000097:blood / Q000172:deficiency; D006801:Humans; D007018:Hypopituitarism / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D007249:Inflammation / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D018836:Inflammation Mediators / Q000097:blood; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood; D024821:Metabolic Syndrome / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D011372:Progestins / Q000627:therapeutic use; D013974:Thyroxine / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D004967:Estrogens; D005938:Glucocorticoids; D018836:Inflammation Mediators; D007328:Insulin; D008055:Lipids; D011372:Progestins; D019382:Human Growth Hormone; D013974:Thyroxine