Abnormal Blood Pressure Dipping Pattern in Women with Hypopituitarism Secondary to Sheehan Syndrome: A Case-Control Study

Objectives: The aims of this study were to assess the 24-hour ambulatory BP levels and to determine the prevalence of abnormal circadian BP dipping patterns in women with hypopituitarism secondary to Sheehan syndrome.
Methods: This was a cross-sectional study including 35 women with complete anterior hypopituitarism secondary to Sheehan syndrome and 47 age- and body-mass index-matched control women. Subjects receiving treatment for hypertension were not included. All participants underwent clinical examination, laboratory tests, and BP measurement using ambulatory 24-hour monitoring. Results: The mean age was 61.3±10.6 years in patients vs 60.5±8.5 years in controls (p=0.720). Compared to controls, women with Sheehan syndrome had a higher prevalence of dyslipidemia (p=0.032) and metabolic syndrome (p=0.028). The prevalence of hypertension was 68% in patients and 62% in controls (p=0.520). Altered day-night BP variation was more frequent in patients (85%) than in controls (54%) (p=0.004). Additionally, patients had a significantly higher prevalence of nocturnal hypertension (38% versus 3%; p=0.002). Sheehan syndrome was positively associated with a non-dipper and riser BP profile (Odds Ratio=4.7, 95% confidence interval: 1.54–14.33, p=0.004).
Conclusion: Women with hypopituitarism secondary to Sheehan syndrome had a higher disruption of the circadian BP rhythm than controls. Although the prevalence of newly diagnosed hypertension was comparable between patients and controls, women with Sheehan syndrome had a higher prevalence of nocturnal hypertension.

Keywords: Blood pressure dipping pattern, GH deficiency, hydrocortisone, hypopituitarism, nocturnal hypertension, Sheehan syndrome