Prothrombin time, activated thromboplastin time, fibrinogen, and D-dimer levels, and von Willebrand activity of patients with Sheehan's syndrome and the effect of hormone replacement therapy
Semir Pasa1, Abdullah Altintas2, Cemil Tumer3 & Mstafa Demircin4
Increased mortality due to atherosclerotic cardiovascular disease has been described in adult patients with hypopituitarism, although the precise underlying mechanisms remain undetermined. Various abnormalities of coagulation and fibrinolysis occur in patients with thyroid diseases. Conversely, there are conflicting reports concerning the effects of growth hormone replacement on coagulation and fibrinolytic pathways in adults with hypopituitarism, and there are limited data on the effects of hypocortisolism on the thrombotic and fibrinolytic systems. Similarly, controversial data were also reported in studies evaluating the effects of estrogen replacement therapy on cardiovascular events and on coagulation factors in post-menopausal women. The aim of this presented study was to investigate the effects of Sheehans syndrome (SS), which is a common cause of hypopituitarism on hemostatic factors and to assess the effects of hormone replacement therapy (HRT), including L-thyroxine, prednisolone, and conjugated estrogen/medroxyprogesterone acetate, on these coagulant factors. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and D-dimer levels, and von-Willebrand factor (vWF) activity were studied in 32 patients with SS and 35 age-matched healthy female control subjects (CS). Decreased PT and aPTT, increased fibrinogen and D-dimer levels, and similar vWF activity were determined in patients with SS as compared with CSs. In addition, it was found that HRT did not significantly affect these coagulation factors, apart from the fibrinogen level.