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Sheehan's Syndrome Revisited: Underlying Autoimmunity or Hypoperfusion?

Sheehan's syndrome remains a frequent obstetric complication with an uncertain pathophysiology. We aimed to assess the incidence of hypopituitarism (≥2 hormonal axis impairment) within the first six postchildbirth months and to determine the existence of anti-pituitary antibodies. From 2015 to...

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Autores principales: González-González, José Gerardo, Borjas-Almaguer, Omar David, Salcido-Montenegro, Alejandro, Rodríguez-Guajardo, René, Elizondo-Plazas, Anasofia, Montes-de-Oca-Luna, Roberto, Rodríguez-Gutiérrez, René
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846385/
https://www.ncbi.nlm.nih.gov/pubmed/29681937
http://dx.doi.org/10.1155/2018/8415860
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author González-González, José Gerardo
Borjas-Almaguer, Omar David
Salcido-Montenegro, Alejandro
Rodríguez-Guajardo, René
Elizondo-Plazas, Anasofia
Montes-de-Oca-Luna, Roberto
Rodríguez-Gutiérrez, René
author_facet González-González, José Gerardo
Borjas-Almaguer, Omar David
Salcido-Montenegro, Alejandro
Rodríguez-Guajardo, René
Elizondo-Plazas, Anasofia
Montes-de-Oca-Luna, Roberto
Rodríguez-Gutiérrez, René
author_sort González-González, José Gerardo
collection PubMed
description Sheehan's syndrome remains a frequent obstetric complication with an uncertain pathophysiology. We aimed to assess the incidence of hypopituitarism (≥2 hormonal axis impairment) within the first six postchildbirth months and to determine the existence of anti-pituitary antibodies. From 2015 to 2017, adult pregnant women, who developed moderate to severe postpartum hemorrhage (PPH), were consecutively included in the study. Pituitary function was assessed 4 and 24 weeks after PPH. At the end of the study, anti-pituitary antibodies were assessed. Twenty women completed the study. Mean age was 26.35 (±5.83) years. The main etiology for severe PPH was uterine atony (65%) which resulted mostly in hypovolemic shock grades III-IV. Within the first four weeks after delivery, 95% of patients had at least one hormonal pituitary affected and 60% of the patients fulfilled diagnostic criteria for hypopituitarism. At the end of the study period, five patients (25%) were diagnosed with hypopituitarism (GH and cortisol axes affected). Anti-pituitary antibodies were negative in all patients. At 6 months follow-up, one in every four women with a history of moderate-to-severe PPH was found with asymptomatic nonautoimmune-mediated hypopituitarism. The role of autoimmunity in Sheehan's syndrome remains uncertain. Further studies are needed to improve the remaining knowledge gaps.
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spelling pubmed-58463852018-04-22 Sheehan's Syndrome Revisited: Underlying Autoimmunity or Hypoperfusion? González-González, José Gerardo Borjas-Almaguer, Omar David Salcido-Montenegro, Alejandro Rodríguez-Guajardo, René Elizondo-Plazas, Anasofia Montes-de-Oca-Luna, Roberto Rodríguez-Gutiérrez, René Int J Endocrinol Research Article Sheehan's syndrome remains a frequent obstetric complication with an uncertain pathophysiology. We aimed to assess the incidence of hypopituitarism (≥2 hormonal axis impairment) within the first six postchildbirth months and to determine the existence of anti-pituitary antibodies. From 2015 to 2017, adult pregnant women, who developed moderate to severe postpartum hemorrhage (PPH), were consecutively included in the study. Pituitary function was assessed 4 and 24 weeks after PPH. At the end of the study, anti-pituitary antibodies were assessed. Twenty women completed the study. Mean age was 26.35 (±5.83) years. The main etiology for severe PPH was uterine atony (65%) which resulted mostly in hypovolemic shock grades III-IV. Within the first four weeks after delivery, 95% of patients had at least one hormonal pituitary affected and 60% of the patients fulfilled diagnostic criteria for hypopituitarism. At the end of the study period, five patients (25%) were diagnosed with hypopituitarism (GH and cortisol axes affected). Anti-pituitary antibodies were negative in all patients. At 6 months follow-up, one in every four women with a history of moderate-to-severe PPH was found with asymptomatic nonautoimmune-mediated hypopituitarism. The role of autoimmunity in Sheehan's syndrome remains uncertain. Further studies are needed to improve the remaining knowledge gaps. Hindawi 2018-02-26 /pmc/articles/PMC5846385/ /pubmed/29681937 http://dx.doi.org/10.1155/2018/8415860 Text en Copyright © 2018 José Gerardo González-González et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
González-González, José Gerardo
Borjas-Almaguer, Omar David
Salcido-Montenegro, Alejandro
Rodríguez-Guajardo, René
Elizondo-Plazas, Anasofia
Montes-de-Oca-Luna, Roberto
Rodríguez-Gutiérrez, René
Sheehan's Syndrome Revisited: Underlying Autoimmunity or Hypoperfusion?
title Sheehan's Syndrome Revisited: Underlying Autoimmunity or Hypoperfusion?
title_full Sheehan's Syndrome Revisited: Underlying Autoimmunity or Hypoperfusion?
title_fullStr Sheehan's Syndrome Revisited: Underlying Autoimmunity or Hypoperfusion?
title_full_unstemmed Sheehan's Syndrome Revisited: Underlying Autoimmunity or Hypoperfusion?
title_short Sheehan's Syndrome Revisited: Underlying Autoimmunity or Hypoperfusion?
title_sort sheehan's syndrome revisited: underlying autoimmunity or hypoperfusion?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846385/
https://www.ncbi.nlm.nih.gov/pubmed/29681937
http://dx.doi.org/10.1155/2018/8415860
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