Pituitary (2006) 9:127–135 DOI 10.1007/s11102-006-9990-9 Two years of growth hormone replacement therapy in a group of patients with Sheehan’s syndrome D´ ebora Vieira Soares · Luciana Diniz Carneiro Spina · Rosane Resende de Lima Oliveira Brasil · Priscila Marise Lobo · Elizabeth Salles · Cla ´ udia Medina Coeli · Fl´ avia L ´ ucia Conceic ¸˜ ao · Mario Vaisman Published online: 30 August 2006 C  Springer Science + Business Media, LLC 2006 Abstract To investigate the effects of GH replacement on lipid proﬁle, carotid artery intima-media thickness (IMT), glucose metabolism and visceral fat in patients with Shee- han’s syndrome, ten patients, mean age 44.8 ± 9.5 yr, com- pared with 10 controls matched for age and body mass index were studied. Total cholesterol, Triglycerides (TG), HDL- c, LDL-c, Apolipoprotein A and B (apoA and apoB) and Lipoprotein (a), serum IGF-1, ultrasonography of the carotid arteries, oral glucose tolerance test (OGTT), HOMA insulin resistance index, insulin sensitivity index (ISI)-composite and abdominal CT scan were performed. When compared to a control group, patients presented lower HDL concentra- tions (p = 0.05) and 2-h OGTT insulin levels (p < 0.04) and increased TG levels (p < 0.04). After 24 months of GH re- placement a reduction in the relation ApoB/ApoA (p = 0.04) was observed, as well as an increase in HDL (p < 0.004). A decrease in carotid artery IMT and in visceral fat over time was found, p < 0.03 and p< 0.04 respectively, though without any signiﬁcant differences during post hoc com- parisons of means, which may be explained by the small number of cases studied, but there was a tendency, p = 0.08 and p = 0.09 respectively. The 2-h OGTT insulin levels increased (p < 0.02) as well as the prevalence of glucose intolerance (prevalence = 42.8%, p < 0.05). GH replace- ment therapy promoted favorable effects on carotid artery IMT, lipid proﬁle and visceral fat in patients with Sheehan’s syndrome. On the other hand, patients developed abnormal glucose tolerance probably due to an increase in insulin re- D. V. Soares () · L. D. C. Spina · R. R. de Lima Oliveira Brasil · P. M. Lobo · E. Salles · C. M. Coeli · F. L. Conceic ¸˜ ao · M. Vaisman Service of Endocrinology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Brazil e-mail: wellbs@terra.com.br sistance, demonstrated by higher insulin levels, despite fa- vorable changes in body composition. keywords Sheehan’s syndrome . Lipids . Atherosclerosis . Carotid artery . Growth hormone deﬁciency . Insulin sensitivity Introduction Studies have reported that hypopituitary patients have an increased mortality compared with to the general popula- tion [1–5]. Some found the increase in mortality to be due to cardiovascular disease [1, 2, 5]. GH deﬁciency (GHD) in adults is associated with a large number of cardiovascular risk factors: adverse lipid proﬁle [6], premature atherosclero- sis [7], abnormal body composition, including reduced lean body mass, weight excess, and increased fat mass with a preponderance of abdominal fat [8], insulin resistance [9], impaired ﬁbrinolysis [10], and decreased exercise capacity [11]. Sheehan’s syndrome was ﬁrst described by Sheehan in 1937 [12]. It is characterized by a clinical picture of hy- popituitarism that occurs as a result of ischaemic pituitary necrosis preceded by a massive hemorrhage at or just after delivery leading to a severe circulatory collapse. Hypopituitarism is a complex condition and combinations of other hormone deﬁciencies, as inappropriate replacement with sex hormones, thyroxine or glucocorticoids, may con- tribute to the increased vascular risk [13]. However, several studies have indicated that GH replacement has beneﬁcial ef- fects on cardiovascular risk factors in hypopituitary patients with GHD [14–16]. On the other hand, GH has potent effects on intermediary metabolism, some of which antagonize the actions of insulin [17, 18]. Springer