Category: Pituitary Disorders/Neuroendocrinology

Monitor: 29

29 - Hypopituitarism other than sellar and parasellar tumors or traumatic brain injury assessed in a tertiary hospital

Thursday, Apr 25
11:00 AM – 11:30 AM

Objective :

Data regarding the etiology, common clinical presentations and biochemical patterns in hypopituitarism is scant for Pakistan. We describe the characteristics of patients with hypopituitarism other than sellar and parasellar tumors or traumatic brain injury from a tertiary care center in Pakistan.


Methods :

We conducted a retrospective descriptive study in the Aga Khan University Hospital, Karachi, Pakistan. We studied all patients presenting with hypopituitarism, between Jan 2004 – Dec 2013. Clinical, hormonal and imaging data pertinent to the study was collected according to inclusion criteria. 


Results :

42% patients presented to the endocrinology clinics at the Aga Khan University Hospital during the study period. Thirty seven patients (88.1%) were females.  Mean age ± standard deviation of the participants was 53.8 ± 14.7 years. 40% of individuals were obese. The median duration of experiencing symptoms was 2.7 years (0.72-5.95 years). Sixteen patients had secondary infertility and all were females; a majority of patients in this group had Sheehan’s syndrome (n=8) followed by empty sella syndrome (n=3), partial empty sella syndrome (n=2), idiopathic cause (n=2) and tuberculoma (n=1). Eighteen females (48.6%) reported inability to lactate. None of the patients had bitemporal hemianopia, optic nerve atrophy or cranial neuropathy.
















 



Discussion :

Hypopituitarism can cause significant mortality and morbidity due to deficiency of essential hormones. As we have excluded sellar and parasellar tumors, which remains the commonest cause, we found that 35.7% of hypopituitarism was attributable to Sheehan’s syndrom. This is probably because the prevalence of Sheehan syndrome is still very common in developing countries, due to inadequate availability of obstetric care. Empty sella syndrome was the next most common cause of hypopituitarism in our study population (23.8%). Most common hormonal deficiency was found to be TSH with 100% of the study population being affected. Most commonly reported symptoms in our study populations was weakness (97.6%).


Conclusion :

We conclude that Sheehan’s syndrome is the most common cause of hypopituitarism after excluding patients of sellar and suprasellar tumors.  Sheehan syndrome can be prevented by provision of adequate obstetric care especially in patients with low socio-economic status.

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Sarwar Malik

Consultant Endocrinologist
Federal Government Polyclinic Hospital, Islamabad

i am currently working as consultant endocrinologist at Ali Medical Centre Islamabad and Associate Physician Endocrinology at Federal Government Polyclinic Hospital Islamabad, Pakistan

Zareen Kiran

Consultat Endocrinologist
Aga Khan University Hospital

I am Consultant Endocrinologist in Aga Khan Universiy Hospital, Karachi and Assistant Professor Endocrinology in Dow University of Health Sciences, Karachi.

Najmul Islam

Professor
Aga Khan University Hospital, Pakistan

Dr Najmul Islam is currently working in Aga Khan University (AKUH) Karachi Pakistan as Professor in Department of Medicine

Sarwar Malik

Consultant Endocrinologist
Federal Government Polyclinic Hospital, Islamabad

i am currently working as consultant endocrinologist at Ali Medical Centre Islamabad and Associate Physician Endocrinology at Federal Government Polyclinic Hospital Islamabad, Pakistan

Muhammad Owais Rashid

Minaz Mawani

Asma Gulab

Muhammad QAMAR.. Masood

Associate Professor
Aga Khan University
Karachi, Pakistan

My research is focused on diabetes and cardiovascular disease risk reduction, both from primary prevention perspective and improving the clinical care. My initial work on identifying the risk factors of diabetes and cardiovascular disease in Pakistani children and with various socioeconomic backgrounds resulted in several publications.

My current research project is a multinational trial titled “Cardiovascular Disease Risk Reduction Strategies in South Asia (CARRS) – A Translational Trial” focused on impact of non-physician care coordinator and decision support software on reducing the risk factors. My other multinational collaborative work was on the use rapid acting insulin analogs during Ramadan.

I have tried to ask real questions which will have impact on the community, vitamin D deficiency which has resurfaced as a significant health issue, has resulted in my work on identifying best strategy for correcting vitamin D deficiency.

So far I have total 30 publications in peer reviewed journals and I have presented my work locally and internationally.