The extent of anterior pituitary dysfunction varies in different series. The main involvement was the secretion of growth hormone (GH) and prolactin (90–100%), while deficiencies in cortisol secretion, gonadotropin and thyroid stimulating hormone (TSH) ranged from 50 to 100%.[6,14–19] At least 75% of pituitary must be destroyed before clinical manifestations become evident. GH deficiency is very common in SS because somatotrophs are located in the lower and lateral regions of the pituitary gland and are most likely to be damaged by ischemic necrosis of the pituitary .