Extensive investigation of 114 patients with Sheehan's syndrome: a continuing disorder (original) (raw)
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Epidemiologic aspects of postpartum pituitary hypofunction (Sheehan’s syndrome)
Fertility and Sterility, 2005
Two hundred seventy-nine (3.20%) of the 8,730 parous females aged 20 -39 years and 124 (4.18%) of 2,970 parous females aged 40 years or older who were screened were suspected to have Sheehan's syndrome; 115 and 55 of these females in the two age groups were fully evaluated, and 98 and 51 of them, respectively, were proven to have Sheehan's syndrome. At these rates, the projected number of women with Sheehan's syndrome among a total population of parous females aged Ն20 years (12,32,827, as per census data) would be 38,691 in the Kashmir valley of the Indian subcontinent. (Fertil Steril 2005;84:523-8.
Sheehan syndrome: clinical and laboratory evaluation of 20 cases
Neuro endocrinology letters, 2005
Sheehan syndrome (SS) or post-partum pituitary necrosis is a pituitary insufficiency secondary to excessive post-partum blood losses. SS is a very significant cause of maternal morbidity and mortality in developing countries although it is a rarity in developed countries in which obstetrical care has been improved. In this study, we reviewed 20 cases retrospectively who were diagnosed as SS in our clinic. The patients aged 40 to 65 years with a mean age of 51.12 +/- 9.44 years (mean +/- SD). Time to make a definitive diagnosis of the disease ranged between 5 and 25 years with a mean of 16.35 +/- 4.74 years. Three of our patient (15%) had a previous diagnosis of SS. Three patients (15%) were referred to emergency service for hypoglycemia, three patients (15%) for hypothyroidism and one patient (5%) for hyponatremia. Dynamic examination of the pituitary revealed GH, Prolactin, FSH, TSH and ACTH insufficiency in all of the patients. One of our patients had a sufficient LH response to L...
Journal of Medical Case Reports, 2021
Background Sheehan's syndrome is hypopituitarism due to pituitary gland necrosis resulting from hemorrhagic shock during pregnancy. It is a rare complication with varied manifestations and a considerable delay in diagnosis. Case presentation We describe the case of a 45-year-old Ethiopian woman who presented with generalized fatigue for 18 years which progressed to anorexia, nausea, vomiting, diarrhea, and abdominal pain of 6 years' duration, for which she was treated symptomatically throughout these years. Complete clinical evaluation, endocrine studies, and pituitary magnetic resonance scan revealed hypopituitarism secondary to Sheehan’s syndrome. She had significant improvement noted following the commencement of hormone replacement therapy. Conclusion Previous case reports describe patients being diagnosed after one or more complications from long-term panhypopituitarism. The present case illustrates that undiagnosed Sheehan's syndrome is associated with long-term mo...
A case of Sheehan syndrome six years postpartum with hypothyroidism and mild hyponatremia
2022
Sheehan syndrome, also referred to as postpartum hypopituitarism is often a sequela of massive post-partum hemorrhage in resource poor healthcare settings where blood loss during delivery is often neglected. The diagnosis of this rare but fatal is disease is often delayed because the symptoms are vague and the pituitary dysfunction is insidious in nature. This condition sometimes takes more than a decade before it is diagnosed. The classic signs and symptoms include agalactia, secondary amenorrhea and dry wrinkling skin. Often an empty or a partially empty sella is seen on magnetic resonance imaging of the brain. We present the case of a 35-year-old multiparous female with anhedonia and raised serum transaminases who presented to our side with mild hyponatremia and hypothyroidism. She got diagnosed with Sheehan syndrome at our set up six years after her last obstetric event. Through this case report, we intend to provide a clinical account of the patient’s condition and management.
Sheehan's syndrome-A review and update
Sheehan's syndrome (SS) is postpartum hypopituitarism caused by necrosis of the pituitary gland. Sheehan's syndrome, though rare, is still one of the commonest causes of hypopituitarism in developing countries like ours. The clinical presentation is variable with abrupt or insidiously developing pituitary insufficiency after a heavy intra-partum or postpartum haemorrhage. It is usually the result of severe hypotension or shock caused by massive haemorrhage during or after delivery. Patients with SS have varying degrees of anterior pituitary hormone deficiency. Its frequency is decreasing worldwide and it is a rare cause of hypopituitarism in developed countries owing to advances in obstetric care. However, it is still frequent in underdeveloped and developing countries. SS often evolves slowly and hence is diagnosed late. History of postpartum haemorrhage, failure to lactate and cessation of menses are important clues to the diagnosis. Basal hormone levels may be enough in patients with typical histories, but most of the patients need more detailed investigation including dynamic pituitary function tests. The presence of anti-pituitary antibodies (APAs) has been demonstrated in some patients with SS, suggesting that an autoimmune pituitary process could be involved in this syndrome. Pituitary MRI and CT may also be helpful for the investigation. Treatment of SS includes replacement of deficient hormone and the early diagnosis and appropriate treatment are important to reduce morbidity and mortality of the patients.
Pituitary Autoimmunity in Patients with Sheehan's Syndrome
Journal of Clinical Endocrinology & Metabolism, 2002
Postpartum hemorrhage (PPH) is a frequent complication of pregnancy in India. Sheehan's description of postpartum hypopituitarism promoted the belief that PPH leads to necrosis of the enlarged pituitary gland of pregnancy and hypopituitarism. However, slow clinical progression suggests factors other than ischemia in its pathogenesis. Tissue necrosis could release sequestered antigens, triggering autoimmunity of the pituitary and delayed hypopituitarism in Sheehan's syndrome. Twenty-six consecutive patients with postpartum hypopituitarism were studied, 19 with Sheehan's syndrome based on a history of PPH and hormone profile suggesting pituitary failure [mean (SD) age 32.7 ؎ 6.4 yr, duration of illness 5.5 ؎ 3.1 yr], and seven patients with no history of PPH, categorized as "Other." Pituitary imaging and basal T 4 , TSH, cortisol, LH, FSH, 17-estradiol, and autoantibodies against
Clinical, hormonal and radiological features of partial Sheehan's syndrome: an Indian experience
Archives of endocrinology and metabolism, 2016
Objective The objective of this study was to describe clinical presentation, hormonal profile and imaging characteristics of 21 patients with partial Sheehan's syndrome. Subjects and methods This prospective study was carried out over a period of six years (2008-2013). The evaluation of patients included clinical assessment, hormone estimations and contrast enhanced magnetic resonance imaging of pituitary. Results We documented preservation of gonadotroph, corticotroph and lactotroph function in 71.4, 61.9, and 9.5% of patients respectively. Conclusion To conclude some of the pituitary functions can be preserved in Sheehan's syndrome and this has important implications from the treatment and long term morbidity point of view.
Pregnancy in Sheehan's syndrome corrected by adrenal replacement therapy. Case report
BJOG: An International Journal of Obstetrics and Gynaecology, 1985
A 23-year-old woman was referred to our Institute in October 1981 for assessment of fatigue, weight loss and postpartum amenorrhoea. The patient, who had had her first pregnancy in 1978 with normal labour and lactation, gave birth at term after a sccond uncomplicated pregnancy in March 1981. The patient noticed a much heavier blood loss at the second delivery than during her first, but she denied loss of consciousness and no blood transfusion was given. lmmediately after delivery, the patient complained of intense fatigue with drowsiness, depression and anorexia. Afterwards, lactation failed and the patient did not resume her menses, which had always been regular. In the subsequent 7 months, there was an involuntary weight loss from 53 to 45 kg, and she continued to complain of diminished vigour, lethargy and apathy.
A decade without diagnosis: Sheehan’s syndrome
Case Reports in Clinical Medicine, 2013
Sheehan's Syndrome (SS) occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. We report a 41-year-old woman with a history of severe postpartum hemorrhage 18 years prior to presentation. During this period of time, she experienced severe fatigue. Three months prior to being admitted to our hospital, the patient started to notice alopecia, generalized edema and cognitive impairment. After proper investigation, laboratory tests and clinical findings indicated panhypopituitarism. In addition to neuroimaging and past medical history, SS was diagnosed and treatment started. We emphasize the importance of thorough investigation, further diagnosis and management of this condition (especially in third world countries), since SS is a neurological and endocrinological emergency and potentially life threatening.