Sheehan's syndrome or postpartum pituitary necrosis is the most common cause of hypopituitarism. It is caused by necrosis of the pituitary gland secondary to ischemia that occurs due to asevere hemorrhage, hypovolemic shock or hypotension during and after delivery. It results in a reduced production of a variety of hormones that help regulate growth, reproduction, and metabolism. Dynamic examination of the pituitary revealed Growth hormone, Prolactin, Follicle-Stimulating hormone, Luteinizant hormone, Thyroid-Stimulating hormone and Adrenocorticotrophic hormone insufficiency in all of the patients. We presents a case of a 27-year-old woman G2 C2 PO AO with a history of eíght years characterized by postpartum failure of lactation postpartum, amenorrhea, loss ofaxillary and pubic hair, signs of hypothyroidism and repetitive hypoglycemic states. In this case, the diagnosis was suspected because of her history, low baseline hormones levels in conjunction with pituitary imaging of empty sella with computed tomography. Treatment is lifelong hormone replacement therapy.
Downloads
Download data is not yet available.
References
Schrager S. Sabo L. Sheehan Syndrome: ARare Complication of Postpartum Hemorrhage. J Am Board Fam Pra~t2001 ;14:389-91.
Kasper D. Braunwald E, Faucci A, Hauser S, Jameson L. Harrison, Principios de Medicina Interna. Volumen 11. 16° Edición. 2004 Pago 2625-40
Boulanger E, Pagniez D, Roueff S. Sheehan syndrome presenting as eariy post-partum hyponatremia. Nephro! Dial Transplant 1999;14: 2714-15.
Otsuka F, Kageyama J, Ogura T, Hattori T, Makino H. Sheehan's syndrome of more than 30 years' duration: an endocrine and MRI study of 6 cases. Endocr J 1998;45:451-8
Garner P. Pituitary disorders in pregnancy. Current of Obstetrics and Gynecologic Diagnosis and Treatment. Ninth Ed. 2003. Pág.135-43.
Ravinder G, Narayana K, Crack P, Jaleel A, Gupta N. Pituitary Autoimmunity in Patients with Sheehan's Syndrome. JCEM 2002 87(9): 4137-41.
Bevan J, Othman S, Lazarus J, ParkesA, Hall R. Reversible adrenocorticotropin deficiency due to probable autoimmune hypophysitis in a woman with postpartum thyroiditis. J Clin Endocrinol Metab 1998;74: 548-52
Caixas A, Albareda M, García Pattterson A. Postpartum Thyroiditis in women with hypothyroidism antedating pregnancy. J Clin Endocrinol Metab 1999;84:4001
Orrego J, Barkan A. Pituitary disorders and drug treatment options. Seventh Ed. 2000. Pág. 59-93.106.
Sheehan H. Postpartum necrosis of the anterior pituitary. J Path Bacteriol1937; 45: 189-214.
Dinc H. Esen F, Demirci A, Sari A, Resit Gumele H. Pituitary dimensions and volume measurements in pregnancy and postpartum. MRI assessment. Acta Radiol 1998; 39:64-9.
Zargar A, Masoodi S, Laway B, Sofi F, WaniA. Pregnancy in Sheehan's syndrome: a report of three cases. J Assoc Physicians India. 1998;46: 476-78
Molitch M, Purdy L. Endocrine Disorders of Pregnancy. Second Ed. 2002. Pág. 465-78
Lamberts S, de Herder W, Van Der Lely A. Pituitary insufficiency. Lancet. 1998;352: 127-34.
Haddow J, Palomaki G, Allan W. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999;341 (8):54955.
W. Munz, R. Seufert, P-G. Knapstein, K. Pollow. Early Postpartum Hyponatremia in a Patient with Transient Sheehan's Syndrome. Exp Clin Endocrinol Diabetes 2004;112: 278-28.
Cheong H, Park H, Ha 1. Six novel mutations in the vasopressin V2 receptor gene causing nephrogenic diabetes insipidus. Nephron 1997; 75:431.
Kriplani A, Goswami D, Agarwal N, Bhatla N, Ammini A. Twin pregnancy following gonadotrophin therapy in a patient with Sheehan's syndrome. Int J Gynaecol Obstet 2000;71 :59-63
Davies J, Obuobie K, Smith J. A therapeutic trial of growth hormone in hypopituitary adults and its infiuence upon continued prescription by general practitioners. Clin Endocrinol 2000;52:295-03.
Davison J, Valloton M, Lindheimer. Plasma osmolality and urinary concentratíons and dilution during and after pregnancy. Br J Obstet Gynecol 1998;88:472-79.
