DHEA on Sexual Function in Sheehan Syndrome: A Randomized Double-Blind Placebo-Controlled Crossover Trial.

CONTEXT: The majority of women with Sheehan syndrome (SS) suffer from sexual dysfunction. Severe androgen deficiency is a major contributory factor. Dehydroepiandrosterone (DHEA) supplementation has been reported to have variable efficacious in improving female sexual dysfunction (FSD) in several trials but studies using DHEA in SS are not available. OBJECTIVE: We aimed to study the use of DHEA supplementation in patients with SS. METHODS: In this crossover trial, 28 participants with SS (age 39.7 ±â€…8.6 years) were divided into 2 groups (using block randomization) who received DHEA supplements (25 mg twice daily) or matched placebo sequentially for 3 months each. Female Sexual Functioning Index (FSFI) score and serum DHEA sulfate (DHEAS) were measured at baseline and after completion of each phase. Glycemic parameters, lipid profile, and liver enzymes were also measured to assess metabolic side effects. RESULTS: There was significant improvement in FSFI score from baseline to end of the study in the DHEA group compared with the placebo group (P = 0.006). Mean FSFI score and most of the individual domains of female sexual dysfunction (FSD) improved with DHEA significantly in both groups (P = 0.001 for each group with DHEA). In those who received DHEA first followed by placebo, FSFI declined significantly after placebo (P = 0.041) but remained at an acceptable level of sexual functioning. Serum DHEAS increased significantly with DHEA treatment. No significant changes in glycemic index, lipid profile, and liver enzymes were noted with DHEA treatment. CONCLUSION: A short duration of DHEA supplementation in women with SS with FSD is efficacious and safe.

Sexual Dysfunction in Sheehan Syndrome.

OBJECTIVE: The study was done to objectively document the sexual function in Sheehan syndrome (SS). SS is not an uncommon cause of hypopituitarism in developing countries. The lack of sex steroids from both ovaries and adrenal glands could lead to sexual dysfunction in SS. Sexual function is a neglected aspect of health in women in developing countries, although it greatly contributes toward the quality of life and feeling of well-being. Objective documentation of sexual function in SS is limited. METHODS: Thirty-two subjects with SS on conventional therapy (except growth hormone) were evaluated. SS was diagnosed as per standard criteria. Sexual function was assessed by validated questionnaires using the Female Sexual Function Index (FSFI). Thirty healthy women of a similar age range and socioeconomic background were included as comparators. RESULTS: The mean age (±SD) of the study population and healthy controls was 39.9 (±8.6) years and 38.2 (±6.8) years, respectively. The median interval between inciting events and diagnosis of SS was 8.3 years (interquartile range, 5.2-13.5 years). Thirty subjects were sexually active. Of the 30 subjects, 28 (93%) had sexual dysfunction, that is, an FSFI score of ≤26.55. The median total FSFI scores of subjects with SS and controls were 20.8 and 29.05, respectively, (P = .001). There was a statistically significant difference for individual parameters of sexual function, including desire, arousal, lubrication, orgasm, and satisfaction, between those with SS and controls. However, the pain during intercourse was not different. FSFI score in subjects with SS was not correlated with any endocrine parameter or duration of the disease since diagnosis. CONCLUSION: Sexual dysfunction is very common, affecting >90% of subjects with SS.

Clinical, Endocrine, Metabolic Profile, and Bone Health in Sheehan's Syndrome.

BACKGROUND: Sheehan's syndrome (SS) occurs due to ischemic pituitary necrosis resulting from severe postpartum hemorrhage (PPH). SS is characterized by varying degrees of pituitary insufficiency involving mostly the anterior lobe. Comprehensive data on SS apart from endocrine dysfunction is scarcely available. MATERIALS AND METHODS: Thirty-eight subjects previously diagnosed with SS were enrolled in this observational study. Their clinical, biochemical, hormonal, radiological data at presentation were recorded from past records and bone density was measured in all. RESULTS: Mean (±SD) age was 39 (±8.7) years and diagnostic delay was 9.3 (±5.5) years. All had history of PPH and lactation failure. About 47% were referred from emergency, and rest 53% were diagnosed from outpatient's department. Mean free T4, TSH, prolactin, morning cortisol, FSH, LH, and IGF-1 were mostly low. Panhypopituitarism was present in 97%. Hyponatremia was most common electrolyte imbalance found in about 53%. More than 40% had elevated transaminases. Dyslipidemia especially low HDL was found in 31 (81.5%) subjects. MRI of hypothalamus-pituitary region showed empty sella in 53% and partial empty sella in 47%. About 13% subjects had diabetes mellitus. Low bone mass (BMD Z-Score ≤-1) was seen in 80% and it was more severe (BMD Z-Score ≤-2) in 44% subjects, affecting predominantly lumbar spine. Bone loss at femoral neck was less prominent. CONCLUSION: Apart from variable spectrum of clinical presentation, subjects with SS have significant abnormalities in serum electrolytes, metabolic parameters. Low bone mass is also a frequent accompaniment.