Case Report Postpartum pituitary necrosis: A report of 2 autopsy cases (original) (raw)

Postpartum Pituitary Necrosis: A Report of 2 Autopsy Cases

Indian Journal of Case Reports, 2017

Major hormonal changes emerge during pregnancy. The pituitary gland is one of the most affected organs with altered anatomy and physiology. Sheehan's syndrome also known as Simmonds's syndrome or postpartum anterior pituitary necrosis is due to ischemic necrosis secondary to blood loss and hypovolemic shock after child birth. We report two autopsy cases of postpartum anterior pituitary necrosis with their clinical correlation. Histopathological examination of pituitary in both the cases showed extensive areas of coagulative necrosis involving the anterior pituitary. Both the cases were associated with indirect causes of maternal deaths like infectious etiology.

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.

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

Pregnancy and pituitary disorders: Challenges in diagnosis and management

Indian Journal of Endocrinology and Metabolism, 2013

Pregnancy is associated with normal physiological changes in endocrine system that assists fetal survival as well as preparation of labor. The pituitary gland is one of the most affected organs in which major changes in anatomy and physiology take place. Due to overlapping clinical and biochemical features of pregnancy, sometimes the diagnosis of pituitary disorders may be challenging. It is important to know what normal parameters of changes occur in endocrine system in order to diagnose and manage complex endocrine problems in pregnancy. In our present review, we will focus on pituitary disorders that occur exclusively during pregnancy like Sheehan's syndrome and lymphocytic hypophysitis and pre-existing pituitary disorders (like prolactinoma, Cushing's disease and acromegaly), which poses signifi cant challenge to endocrinologists.

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...

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.

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.

CASE REPOR T Sheehan Syndrome: Clinical and laboratory evaluation of 20 cases

2000

Sheehan syndrome; pituitary insuffi ciency; empty sella Abstract Sheehan syndrome (SS) or post-partum pituitary necrosis is a pituitary insuffi - ciency secondary to excessive post-partum blood losses. SS is a very signifi cant 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,