Evaluation of endothelial functions in patients with sheehan syndrome and the effect of hornone replacement treatment without growth hormone on endothelial functions

5-SUMMARYIn this study we aimed to examine the endothelial functions of patients withSheehan syndrome, a common cause of panhypopituitarism, and to eveluate the effects of?hormone replacement treatment except growth hormone? (HRTwGH) on endothelialfunctions.SUBJECTS and METHODS: Twenty-four patients with Sheehan syndrome agedwith 40.83± 6.43 years and 25 healthy control women aged with 41.13±6.51 years wereincluded to study. Baseline endothelial functions evaluated in both patient and controlgroups. After treatment with prednisolon 5-7.5 mg/d, L-thyroxin 100-200 µg/d, and sexhormone replacement for patients under 40 years of age (conjugated estradiol 0.625 mg/dand medroxyprogesteron acetate 5 mg/d) for 15 months, the patient group reevaluated forendothelial functions. Endothelial functions were determined radiologically with highresolution ultrasond by evaluation of flow mediated dilatation (FMD) and biochemicallywith serum nitric oxide (NO) level. These data were compared by paired samples andindependent t tests.RESULTS: Before of HRTwGH systolic and diastolic blood pressure were lowerthan control subjects. Blood pressure increased with HRTwGH (p=0,02 for systolic; andp=0,01 for diastolic blood pressure), but it could not reach to the level of healthy controlpeople (p=0.001 for systolic and diastolic blood pressure). The high pretreatment serumVLDL-cholesterol and tryglyceride levels of patients than controls (p=0,001 and p=0,01respectively) did not change with HRTwGH (p=0,002 and p=0,04 respectively). SerumCRP level was higher in pretreatment patients than healthy control group (p=0,02), but itdecreased to level of control group after HRTwGH. Pretreatment baseline and stimulatedby FMD NO levels of patients were higher (baseline NO level was 16.87±4.04 µol/L inSheehan syndrome, and 11.8±2.14 µol/L in healthy controls; FMD stimulated NO levelwas 18.79±4.4 µmol/L in Sheehan syndrome and 14.92±2.44 µmol/L in healthy control)and baseline arterial diameter was smaller than healthy control group (baseline arterialdiameter was 3.74±0.68 mm in Sheehan syndrome and 4.62±0.42 mm in healthy control;p=0,0001). FMD stimulated NO level increment ratio and arterial diameter dilation ratiowere also lower in Sheehan syndrome group than healthy control group before treatment(FMD stimulated NO level increment ratio was 13.16±5.57% in pretreatment patients and26.38±8.89% in healthy controls; p=0,0001; and FMD stimulated arterial diameter dilation12ratio was 13.42±6.57% in pretreatment patients and 18.93±5.64 in healthy control;p=0,003). The baseline and stimulated NO levels in Sheehan syndrome group were higherthan healthy control after treatment (baseline NO level were 17.58±4.3 µmol/L in patientafter treatment and 11.8±2.14 µmol/L in healthy controls; and stimulated NO level byFMD was 21.12±4.85 µmol/L in patients after treatment and 11.92±2.44 µmol/L in healthycontrols; p=0.0001). NO level increment ratio increased after treatment and reached tosimilar level of healthy control group. Arterial diameter was smaller in Sheehan syndromethan healthy control group after treatment (arterial diameter was measured 3.61±0.62 mmin patient after treatment, and 4.62±0.42 mm in healthy controls; p=0,0001); but FMDstimulated arterial diameter dilation ratio of patients increased and reached to the similarlevel of control group after HRTwGH. Baseline NO level of patients did not change withtreatment but FMD stimulated NO level and the NO increment ratio was found assignificantly higher after treatment (FMD stimulated NO level of patients were 18.79±4.4µmol/L before treatment, and 21.12±4.85 µmol/L after treatment; the increment ratioswere 13.16±5.57% before treatment and 22.83±8.57% after treatment; p=0,0001). Baselinearterial diameter did not change after treatment, but FMD stimulated arterial diameterdilation ratio increased significantly (arterial diameter dilation ratios were 13.42±6.57%before treatment, and 21.73±10.13% after treatment; p=0,0001).CONCLUSION:1. HRTwGH may have benefical effects on systolic and diastolic blood pressure,and serum CRP level in Sheehan syndrome patients.2. Patients with Sheehan syndrome appear to have endothelial dysfunction causedby inflammation, and HRTwGH may restore endothelial functions.3. Increased expression of eNOS caused by inflammation may responsible fromendotheial dysfunction. Improvement in endothelium and decrement in CRP level havebeen thought that HRTwGH may have anti-inflammatory and may be anti-atheroscleroticeffects.13