Evaluation of the periodontal status of a patient diagnosed with Sheehan syndrome: A case report

Abstract

Aim: Some immunological changes occurring in mothers during pregnancy increase their susceptibility to infections, including periodontal infections. Sheehan syndrome (SS) is a disease that occurs because of severe postpartum hemorrhage causing ischemic pituitary necrosis. The presence of multiple hormonal deficiencies leads to the impairment of bone microarchitecture, which can cause osteopenia and even osteoporosis. Osteoporosis and periodontitis are both chronic diseases characterized by bone loss. Moreover, recent studies have shown that there is a relationship between menopause, osteoporosis, alveolar bone resorption, and tooth loss. This case report aims to evaluate the oral and periodontal status of a patient with SS and to raise awareness about dental and periodontal problems that may occur in such patients. Methodology: A 63-year-old female patient diagnosed with SS in the endocrinology clinic was referred to the periodontology clinic with complaints of multiple tooth loss, mobility in her teeth, and gingival bleeding. In the clinical and radiographic examination of the patient, it was determined that all teeth had horizontal bone resorption; moreover, there was mobility in the mandibular anterior teeth and hemorrhage in the gums. When the patient’s laboratory results were examined, it was seen that the basal plasma levels of free triiodothyronine (T3) and thyroxine (T4), growth hormone (GH), prolactin (PRL), follicle stimulating hormone (FSH), luteinizing hormone (LH), progesterone, and total testosterone values were significantly lower, and the anterior pituitary elevation was significantly decreased in pituitary magnetic resonance (MR) imaging. Conclusion: The periodontium is the target tissue of sex and other hormones. Hormonal changes may affect the inflammatory–immune tissue responses of periodontal tissues. Many studies have shown that thyroid and sex hormones affect oral and especially periodontal tissues. The degradation of hormonal hemostasis may induce a series of pathological events in the oral environment, resulting in inflammatory changes in gingival tissues, periodontal attachment losses, and destruction of the alveolar bone. Systemic diseases that affect hormonal conditions, such as SS, must be considered in the evaluation of oral health. Medical physicians should refer their patients to the dentist for consultation when evaluating patients’ hormonal status and planning their treatment.