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Varied presentations of Sheehan's syndrome at diagnosis: A review of 18 patients

INTRODUCTION: Sheehan's syndrome (SS) occurs due to ischemic pituitary necrosis as a result of severe postpartum hemorrhage (PPH). AIMS AND OBJECTIVES: The aim of the present study was to review the presenting features of SS at diagnosis. MATERIALS AND METHODS: We retrospectively reviewed 18 ca...

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Autores principales: Sanyal, Delmalya, Raychaudhuri, Moutusi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3603054/
https://www.ncbi.nlm.nih.gov/pubmed/23565406
http://dx.doi.org/10.4103/2230-8210.104067
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author Sanyal, Delmalya
Raychaudhuri, Moutusi
author_facet Sanyal, Delmalya
Raychaudhuri, Moutusi
author_sort Sanyal, Delmalya
collection PubMed
description INTRODUCTION: Sheehan's syndrome (SS) occurs due to ischemic pituitary necrosis as a result of severe postpartum hemorrhage (PPH). AIMS AND OBJECTIVES: The aim of the present study was to review the presenting features of SS at diagnosis. MATERIALS AND METHODS: We retrospectively reviewed 18 cases of SS at diagnosis. Presenting clinical features, laboratory data, pituitary hormone deficiencies, and magnetic resonance imaging (MRI) of the sella were analyzed. RESULTS: Age ranged from 28-71 years with a mean age of 47 ± 14.44 years. Time to diagnosis of SS was 6-33 years with a mean of 15.35 ± 6.74 years. Four (22.2%) patients were referred from emergency for hyponatremia, one each (5.6%) for hypotension, hypoglycemia, and vomiting. Three (16.7%) patients presented with asthenia and weight loss, two (11.1%) with slightly raised thyroid stimulating hormone (TSH). Only six (33.3%) presented with classic features of amenorrhea. None presented with isolated lactational failure or apoplexy after PPH. Seventeen (94.4%) patients had lactational failure; thirteen (72.2%) did not menstruate following last delivery. Lactotroph and gonadotroph failure were present in all at diagnosis but corticotrophs preservation was documented in three (16.7%) and thyrotroph in two (11.1%) patients. Twelve (66.7%) patients had empty sella while six (33.3%) had partial empty sella on MRI. CONCLUSION: SS has variable features at diagnosis and may present to different specialties. The clinical features of hypopituitarism are often subtle, leading to delay in diagnosis. History of PPH, lactational failure and cessation of menses are important clues. Thyrotroph, corticotroph axis may be preserved in some SS patients.
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spelling pubmed-36030542013-04-05 Varied presentations of Sheehan's syndrome at diagnosis: A review of 18 patients Sanyal, Delmalya Raychaudhuri, Moutusi Indian J Endocrinol Metab Brief Communication INTRODUCTION: Sheehan's syndrome (SS) occurs due to ischemic pituitary necrosis as a result of severe postpartum hemorrhage (PPH). AIMS AND OBJECTIVES: The aim of the present study was to review the presenting features of SS at diagnosis. MATERIALS AND METHODS: We retrospectively reviewed 18 cases of SS at diagnosis. Presenting clinical features, laboratory data, pituitary hormone deficiencies, and magnetic resonance imaging (MRI) of the sella were analyzed. RESULTS: Age ranged from 28-71 years with a mean age of 47 ± 14.44 years. Time to diagnosis of SS was 6-33 years with a mean of 15.35 ± 6.74 years. Four (22.2%) patients were referred from emergency for hyponatremia, one each (5.6%) for hypotension, hypoglycemia, and vomiting. Three (16.7%) patients presented with asthenia and weight loss, two (11.1%) with slightly raised thyroid stimulating hormone (TSH). Only six (33.3%) presented with classic features of amenorrhea. None presented with isolated lactational failure or apoplexy after PPH. Seventeen (94.4%) patients had lactational failure; thirteen (72.2%) did not menstruate following last delivery. Lactotroph and gonadotroph failure were present in all at diagnosis but corticotrophs preservation was documented in three (16.7%) and thyrotroph in two (11.1%) patients. Twelve (66.7%) patients had empty sella while six (33.3%) had partial empty sella on MRI. CONCLUSION: SS has variable features at diagnosis and may present to different specialties. The clinical features of hypopituitarism are often subtle, leading to delay in diagnosis. History of PPH, lactational failure and cessation of menses are important clues. Thyrotroph, corticotroph axis may be preserved in some SS patients. Medknow Publications & Media Pvt Ltd 2012-12 /pmc/articles/PMC3603054/ /pubmed/23565406 http://dx.doi.org/10.4103/2230-8210.104067 Text en Copyright: © Indian Journal of Endocrinology and Metabolism http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Brief Communication
Sanyal, Delmalya
Raychaudhuri, Moutusi
Varied presentations of Sheehan's syndrome at diagnosis: A review of 18 patients
title Varied presentations of Sheehan's syndrome at diagnosis: A review of 18 patients
title_full Varied presentations of Sheehan's syndrome at diagnosis: A review of 18 patients
title_fullStr Varied presentations of Sheehan's syndrome at diagnosis: A review of 18 patients
title_full_unstemmed Varied presentations of Sheehan's syndrome at diagnosis: A review of 18 patients
title_short Varied presentations of Sheehan's syndrome at diagnosis: A review of 18 patients
title_sort varied presentations of sheehan's syndrome at diagnosis: a review of 18 patients
topic Brief Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3603054/
https://www.ncbi.nlm.nih.gov/pubmed/23565406
http://dx.doi.org/10.4103/2230-8210.104067
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