PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “SHEEHAN'S SYNDROME”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed1992

[Importance of prolactin level indication in detection of Sheehan syndrome].

Prolactin (PRL) levels were studied in 5 women with Sheehan syndrome before and after metoclopramide (MCP, 10 mg i.v.) and domperidone (MOT, 10 mg i.v.) stimulation. The levels of PRL were measured by RIA method. The obtained results were compared with control group (10 female volunteers). Decreased serum level of PRL was found in 3 women before stimulation in comparison with control group. The highest serum concentration of PRL was found 30 min after MOT and MCP injection. In group of women with Sheehan syndrome the level of PRL was not significantly increased in MCP-test. In MOT-test the level of this hormone did not change. The findings of the present investigation suggest that measurement of PRL serum levels in MOT-test could be of value in early diagnosis of Sheehan syndrome.

Adult↗
PubMed1975

[Simmonds-Sheehan syndrome].

A woman of 30 with Simmonds--Sheehan syndrome is described that developed after delivery by vacuum-extraction of the fetus, due to powerless labour. The clinical picture was dominated by suprarenal cortical insufficiency, manifested with pains in the abdomen, vomiting, hypotonia and severe asthenic-adynamic syndrome. The substitutional hormonal treatment completely restored the general state and the working capacity of the patient.

Adult↗
PubMed2001

Sodium and water disturbances in patients with Sheehan's syndrome.

Sheehan's syndrome has been attributed to ischemic damage of the pituitary gland or hypothalamic-pituitary stalk during the peripartum period. Well-described clinical features of Sheehan's syndrome include hypothyroidism, adrenal insufficiency, hypogonadism, growth hormone deficiency, hypoprolactinemia, and different sodium and water disturbances. The occurrence of sodium and water disturbances associated with Sheehan's syndrome depends on the degree of pituitary damage, time of onset since the initial pituitary insult, and concurrent medical conditions that also may play a role in sodium and water balance. We present a patient with Sheehan's syndrome with severe chronic hyponatremia; discuss a potential problem in the patient's management; and review the literature for various sodium and water disturbances, including acute and chronic hyponatremia as well as overt and subclinical central diabetes insipidus. Although Sheehan's syndrome is more prevalent in developing countries, the increasingly large immigrant population within the United States warrants better awareness of this syndrome and its potential complicating sodium and water disturbances. Prompt diagnosis and an understanding of the pathogenic mechanisms of sodium and water disturbances associated with Sheehan's syndrome may avoid potential treatment-related complications.

Cesarean Section↗
PubMed2003

Sheehan's syndrome.

Sheehan's syndrome occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. It may be rarely seen without massive bleeding or after normal delivery. Improvement in obstetric care and availability of rapid blood transfusion coincided with a remarkable reduction in the frequency of Sheehan's syndrome particularly in western society. But it has recently been reported more often from well-developed countries. It is one of the most common causes of hypopituitarism in underdeveloped or developing countries. Enlargement of pituitary gland, small sella size, disseminated intravascular coagulation and autoimmunity have been suggested to play a role in the pathogenesis of Sheehan's syndrome in women who suffer from severe postpartum hemorrhage. The patients may seek medical advice because of various presentations ranging from non-specific symptoms to coma and the clinical manifestation may change from one patient to another. Failure of postpartum lactation and failure to resume menses after delivery are the most common presenting symptoms. Although a small percentage of patients with Sheehan's syndrome may cause abrupt onset severe hypopituitarism immediately after delivery, most patients have a mild disease and go undiagnosed and untreated for a long time. It may result in partial or panhypopituitarism and GH is one of the hormones lost earliest. The great majority of the patients has empty sella on CT or MRI. Lymphocytic hypophysitis should be kept in mind in differential diagnosis. In this review, the old and recent data regarding Sheehan's syndrome are presented.

Diagnosis, Differential↗
PubMed2005

Sheehan syndrome: clinical and laboratory evaluation of 20 cases.

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 LHRH challenge. All of the patients were imaged with pituitary MRI. Eleven patients had empty sella and 9 patients had partial empty sella. SS is still a common problem in our country, especially in rural areas. Considering the duration of disease, important delays occur in diagnosis and treatment of the disease.

Adult↗
PubMed2006

Characteristic features of 20 patients with Sheehan's syndrome.

Sheehan's syndrome occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. The aim of the present study was to determine the clinical characteristics of Sheehan's syndrome in 20 patients (mean age 60.15 +/- 3.41 years) with typical obstetric history. The mean duration between time of diagnosis and date of the last delivery was 26.82 +/- 2.52 years (range 2-40 years). All patients had a history of massive hemorrhage at delivery and physical signs of Sheehan's syndrome. Fourteen patients (70.0%) lacked postpartum milk production and did not menstruate following delivery. Baseline and stimulated anterior pituitary hormone levels were measured in all patients. According to the hormonal values, 18 (90.0%) patients had secondary hypothyroidism, 11 (55.0%) had adrenal failure and all of them had hypogonadism, prolactin and growth hormone deficiency. Hyponatremia was present in seven patients (35.0%). Total or partially empty sella was revealed in all patients by magnetic resonance imaging. Diabetes insipidus was not found in any patient. We found that lack of lactation in the postpartum period and early menopause seemed the most important clues for diagnosis of Sheehan's syndrome, and inadequate prolactin and gonadotropin responses to stimulation tests were the most sensitive diagnostic signs in patients with severe postpartum hemorrhage.

Adrenocorticotropic Hormone↗
PubMed2005

Spontaneous pregnancy and partial recovery of pituitary function in a patient with Sheehan's syndrome.

Sheehan's syndrome is caused by pregnancy-related hemorrhage leading to ischemic necrosis of the anterior pituitary gland and hypopituitarism. Spontaneous pregnancy in Sheehan's syndrome is very rare. We report the case of a patient with Sheehan's syndrome who suffered from anterior pituitary insufficiency, but with sparing of gonadotropic function. The patient became pregnant spontaneously and, after her second delivery, thyrotropic function recovered. However, the patient's growth hormone and cortisol levels remained unresponsive to an insulin-tolerance test. This case demonstrates that pituitary function may recover from less extensive pituitary ischemia. We emphasize the importance of early identification of pregnancy in such cases. It is crucial to institute adequate hormone-replacement therapy during pregnancy, since hypopituitarism is associated with high fetal and maternal morbidity and mortality.

Adrenal Insufficiency↗
PubMed2003

[Irreversible coma following hypoglycemia in Sheehan syndrome with adrenocortical insufficiency].

A 24-year-old woman of Somali origin delivered at term after an uncomplicated pregnancy. Post-partum haemorrhage resulted in hypovolaemic shock which was treated by hysterectomy. Five days later she became comatose due to unrecognised hypoglycaemia which caused severe irreversible brain damage and status epilepticus. Treatment in the intensive care unit with artificial respiration, prednisolone, desmopressin, inotropic support, barbiturates and an anaesthetic under EEG guidance was unsuccessful. The patient died 28 days post-partum. The hypoglycaemia was due to a combination of (a) inadequate glucose intake and (b) lack of counter-regulatory mechanisms due to a deficiency of steroids and growth hormone as a result of loss of pituitary function (Sheehan syndrome) together with adrenocortical insufficiency. The combination of Sheehan syndrome and primary adrenocortical insufficiency has not been described previously in the literature.

Adrenal Insufficiency↗
PubMed1995

[A case of postoperative hyponatremia caused by Sheehan syndrome associated with lung carcinoma].

A 54-year-old woman underwent a left upper lobectomy for lung carcinoma after which hyponatremia developed within 5 days. Her serum concentration of ADH was within normal range disapproving the presence of SIADH frequently associated with lung carcinoma. An endocrinological examination showed panhypopituitarism. From her anamnesis it was seen that there was much perinatal bleeding and amenorrhea. She was diagnosed as suffering from Sheehan syndrome. She was treated with glucocorticoid and beneficial results were obtained. Her serum concentration of natrium returned to normal and she discharged on the 74th postoperative day. We present this paper because we had difficulty in determining that she had Sheehan syndrome, and think that a careful search for a diagnosis before operation is important for the management of the patient during the perioperative and postoperative period.

Adenocarcinoma↗
PubMedDate not supplied

Sheehan syndrome: a splinter of the mind.

A 40-year-old woman presented with headache and diplopia after hypotension from postpartum hemorrhage. A noncontrasted cranial magnetic resonance imaging (MRI) showed an enlarged pituitary with a rim of slight increased signal. A repeat gadolinium-enhanced cranial MRI showed peripheral enhancement of the pituitary gland surrounding an isointense central area consistent with infarction of the pituitary and the clinical diagnosis of Sheehan syndrome. The patient was treated with intravenous hydrocortisone. Immediately after treatment, her symptoms remitted and the examination normalized. One month later, a gadolinium-enhanced cranial MRI was normal. The characteristic appearance of the post-gadolinium enhanced cranial MRI helped confirm the diagnosis of Sheehan syndrome and facilitate early treatment with corticosteroids.

Adult↗
PubMed2001

A case of hypopituitarism associated with Hashimoto's thyroiditis and candidiasis: lymphocytic hypophysitis or Sheehan's syndrome?

Sheehan's syndrome and lymphocytic hypophysitis often occur in relation to pregnancy, making their differentiation difficult. We describe a 52-yr-old woman with hypopituitarism, Hashimoto's thyroiditis and candidiasis. She was admitted to our hospital because of nausea, vomiting and constipation. Her menstruation stopped in her early thirties. She thereafter developed kyphosis and loss of axillary and pubic hair. Levels of serum Na, Cl and glucose were all low, and hormonal studies were consistent with anterior pituitary hypofunction. Although she had blood transfusion because of hemorrhage at her first delivery, the delivery of her second child was normal followed by resumption of regular menstruation. In addition to hypopituitarism, she had Hashimoto's thyroiditis and candidiasis. Laboratory tests showed an increased Thl ratio, which is related to induction of cellular immunity, and the presence of HLA DR4, which is often associated with polyglandular autoimmune syndrome. These results suggested that the pituitary lesion might be due to lymphocytic hypophysitis rather than Sheehan's syndrome.

CD4-Positive T-Lymphocytes↗
PubMed1989

[Sheehan syndrome and spontaneous pregnancy: report of 2 cases].

Two patients receiving substitution therapy for Sheehan syndrome became pregnant. No pituitary trophins, except LH responded to stimulation with the hypothalamic hormones TRH and Gn-Rh, or insulin induced hypoglycemia. Computed tomography showed a normal size sella with arachnoid cyst.

Adult↗
PubMed2005

[Nontraumatic ethmoid cerebrospinal fluid rhinorrhea complicating Sheehan syndrome].

INTRODUCTION: Treatment of pituitary macroadenoma frequently leads to nontraumatic cerebrospinal fistula and rhinorrhea. We report an unusual case of rhinorrhea in a woman with Sheehan's syndrome. CASE: A 39-year-old woman receiving hormone replacement therapy for hypothyroidism diagnosed 13 years earlier (Sheehan's syndrome) developed metabolic syndrome, which combining obesity, type 2 diabetes, hypertension and mixed hyperlipidemia. Cerebrospinal fluid rhinorrhea was confirmed by measurement of the glucose concentration in her nasal discharge and by cerebral MRI, which revealed a fistula of the ethmoid bone and an empty sella. Etiological screening was negative, and normal bone densitometry as well as the absence of trauma ruled out any bone defects. Conversely, the metabolic syndrome, notably obesity, suggested a nontraumatic mechanism for the empty sella. DISCUSSION: Onset of empty sella syndrome during treatment for Sheehan's syndrome may be the cause of the CSF rhinorrhea. The role of obesity requires further investigation.

Adult↗
PubMed1988

Sheehan's syndrome.

Sheehan's syndrome, or postpartum pituitary necrosis, is rarely seen today, but it may occur in women who have more difficult deliveries. The syndrome may be subclinical in some patients and may manifest only if these patients are stressed. Diagnosis is based on laboratory studies, including hormone levels and hormone stimulation tests. Replacement hormone therapy, with careful follow-up of laboratory and clinical results, is the treatment.

Diagnosis, Differential↗
PubMed1981

Serum prolactin during pregnancy induced by pituitary gonadotrophins in a patient with post partum hypopituitarism (Sheehan syndrome).

With the purpose of investigating if placental prolactin production had an influence on maternal prolactin serum concentrations, this hormone was quantitated in serum of a women with partial Sheehan syndrome (deficient gonadotrophin and prolactin production). Her pregnancy was induced by pituitary gonadotrophins and the deficient prolactin pituitary reserve was shown by means of pituitary stimulation test with metoclopramide of pituitary stimulation test with metoclopramide and TRH. Quantitative analysis of prolactin was made by RIA utilizing the double antibody method. Serum prolactin concentrations remained persistently low during pregnancy with a minimal increase (1 - 16 ng/ml) at the end of pregnancy when comparing with concentrations observed in normal pregnant women (20 +/- 10 ng/ml at the beginning of pregnancy, and 250 +/- 150 ng/ml mean +/- 3 SD at the end). Prolactin concentration in the umbilical cord was found to be within normal values (252 ng/ml). Results obtained showed that fetal and placental prolactin does not pass on to the mother and confirm the idea that maternal serum prolactin during pregnancy is exclusively of a maternal pituitary origin.

Adult↗
PubMedDate not supplied

[Sheehan syndrome in the Republic of Niger. 19 cases].

From February 1983 to December 1985, the authors investigated 19 african women with Sheehan's syndrome in Niamey (Republic of Niger). A 15 points diagnostic score was systematically used. Two signs were indispensable for the diagnosis: post-partum agalactia (or severe hypogalactia) and amenorrhea. At least 9 points score was found for every case. Eighteen patients lived along a major road in Niamey and in Dosso departments. The prevalence of this disease is probably important but many cases were not diagnosed since there was no medical examination. Sheehan's syndrome was predominantly diagnosed among Fulani women. Young women (mean age: 26 years) in intensive sexual life, primiparous (8/9) or multiparous (11/19) were concerned. Emergence circumstances of signs were: childbirth at home (18/19), severe vaginal bleeding at placental birth (14/19), rare transfusions (2/19). The infant of a mother with Sheehan's syndrome had a poor prognosis: 9 deaths among 11 deliveries for multiparous, 7/8 for monoparous. The infants were stillborn or more often dead during the first months. Deaths were in relation to absence of maternal lactation. For the primiparous, then infertile women because of hypopituitarism, the repudiation becomes often the only social way of life. Lasting hormonotherapy was not available because 18/19 patients were very poor. Prevention is not possible before long, especially in primiparous, because of: the mentality: the first delivery at home with the mother is the traditional habit; the importance of the required measures.

Adolescent↗
PubMed1996

Cortical laminar necrosis and central pontine myelinolysis in a patient with Sheehan syndrome and severe hyponatremia.

Hypoxic encephalopathy and osmotic demyelination are independent clinical entities. We describe a rare case with these two complications as demonstrated by magnetic resonance imaging (MRI). A 58-year-old woman had adrenal crises twice a decade due to Sheehan syndrome. At the second crisis, hyponatremia was remarkable with consciousness disturbance which was rapidly corrected by intravenous administration of glucocorticoid and hypertonic saline. The maneuver improved consciousness disturbance, but resulted in hypokalemic ventricular fibrillation with circulatory failure. After the normalization of the circulation, however, her consciousness level deteriorated again. Repeated brain MRI revealed acute and chronic phases of cortical laminar necrosis and central pontine myelinolysis.

Brain↗