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2019, Journal of Medical Science And clinical Research
Sheehans Syndrome (SS) is postpartum hypopituitarism caused by ischemic necrosis of the pituitary gland. Usually it results from severe hypotension or shock caused by massive haemorrhage during or after delivery. Enlargement of pituitary gland, small sellar size, DIC and autoimmunity are considered as other causal factors. Its incidence is currently decreasing in developed countries owing to improved obstretic care. We are here by presenting a case report of 53 year old female who had history of PPH during her second pregnancy, presented to casuality with complaints of fever, vomiting, loose stools and shortness of breath. On evaluation she was diagnosed as SCRUB typhus and found to have pancytopenia which did not improve with the treatment of underlying infection. In due course patient developed hyponatremia. On subsequent evaluation she was diagnosed to have hypocortisolism and hypothyroidism. MRI Pituitary was suggestive of SHEEHANS SYNDROME. In view of non specific presentation and little importance paid to the menstrual history there was a delay in the diagnosis and treatment.
International Journal of Advanced Research (IJAR), 2025
Introduction:Postpartum hypopituitarism has been known as Sheehan syndrome since 1937. It is often an insidious revelation but can also be an acute one with coma and collapse, which was the case of our patient reported below. Clinical case: Patient aged 37, admitted to the intensive care unit in a state of anasarca and coma. In view of her clinical features associated with hyponatremia, acute adrenal insufficiency was suspected. requiring degressive boluses of hydrocortisone hemisuccinate. The diagnosis was supported by biological evidence. Subsequent medical records revealed a haemorrhagic haemorrhagic childbirth dating back 6 years with absence of lactation and progressively incapacitating physical and psychological asthenia. Sheehans syndrome was suspected in this clinical situation and confirmed on MRI. The patient was put on daily oral replacement of the deficient axes. Discussion: Myxedema coma is exceptional in Sheehans syndrome. Severe forms require an initial stay in intensive care, followed by multidisciplinary consultation in order to manage the multiple complications and to introduce hormone replacement therapy.
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.
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...
Acta bio-medica: Atenei Parmensis
Sheehan's syndrome is a well-known cause of panhypopituitarism secondary to pituitary apoplexy, that generally occurs after an intra-or postpartum bleeding episode characterized by severe hypertension or hemorrhagic shock. The diagnosis can be difficult and is often formulated after some years from the syndrome occurrence. We report the case of a woman with an early diagnosis of early-onset Sheehan's syndrome associated with severe hyponatremia following dystocic childbirth complicated by postpartum hemorrhage. (www.actabiomedica.it)
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
Cureus
Sheehan syndrome is often a sequela of massive postpartum hemorrhage in resource-poor healthcare settings where blood loss during delivery is often neglected. The diagnosis of this rare but fatal disease is often delayed because the symptoms are vague and the pituitary dysfunction is insidious in nature. We report the case of a 35-year-old multiparous female with anhedonia and raised serum transaminases. She presented with constitutional symptoms. Her last vaginal delivery, six years back, was the last obstetric event that yielded a stillbirth child. She had had amenorrhea since then. Upon further evaluation, she was found to have a massive pericardial effusion, hypopituitarism, and a partially empty sella. This case report highlights the uncharacteristic symptoms that a patient presents with which ultimately lead to delayed diagnosis. Early diagnosis can go miles in improving the quality of life of the patient besides saving the patient from an adrenal crisis.
Journal of Medical Case Reports, 2021
Background Sheehan's syndrome is hypopituitarism due to pituitary gland necrosis resulting from hemorrhagic shock during pregnancy. It is a rare complication with varied manifestations and a considerable delay in diagnosis. Case presentation We describe the case of a 45-year-old Ethiopian woman who presented with generalized fatigue for 18 years which progressed to anorexia, nausea, vomiting, diarrhea, and abdominal pain of 6 years' duration, for which she was treated symptomatically throughout these years. Complete clinical evaluation, endocrine studies, and pituitary magnetic resonance scan revealed hypopituitarism secondary to Sheehan’s syndrome. She had significant improvement noted following the commencement of hormone replacement therapy. Conclusion Previous case reports describe patients being diagnosed after one or more complications from long-term panhypopituitarism. The present case illustrates that undiagnosed Sheehan's syndrome is associated with long-term mo...
Indian Journal of Endocrinology and Metabolism, 2012
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,
European journal of endocrinology / European Federation of Endocrine Societies, 2014
Sheehan's syndrome (SS) is a well-known cause of hypopituitarism resulting from postpartum pituitary necrosis. Because of its rarity in Western society, its diagnosis is often overlooked. We aimed to investigate the clinical, laboratory, and radiological aspects of SS in a large number of patients. A retrospective assessment of the medical records of 114 patients with SS was conducted. In addition, sella turcica volumes of 29 healthy women were compared with those of patients by magnetic resonance imaging examinations. The mean period of diagnostic delay was 19.7 years in patients with SS. It was found that 52.6% of patients had nonspecific complaints, 30.7% had complaints related to adrenal insufficiency, and 9.6% had complaints related to hypogonadism when diagnosed. At the time of diagnosis, 55.3% of the patients had panhypopituitarism, while 44.7% had partial hypopituitarism. The number of deficient hormones was found to be increased over the years. None of the patients whos...
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.
The Journal of Critical Care Medicine
Sheehan’s syndrome is a life-threatening endocrine emergency seen in postpartum females secondary to ischemic pituitary necrosis. It is a frequent cause of hypopituitarism in developing countries that occurs secondary to postpartum haemorrhage (PPH). Patients with Sheehan’s syndrome often present with organ dysfunctions in critical care settings, secondary to stressors precipitating the underlying hormonal deficiencies. The initial clinical picture of Sheehan’s syndrome may mimic some other disease, leading to misdiagnosis and diagnostic delay. Strict vigilance, timely diagnosis, and appropriate management are essential to avoid diagnostic delay and to improve the patient outcome. In this case series, we describe 5 cases of previously undiagnosed Sheehan’s syndrome (including young, middle aged and postmenopausal females) that presented to critical care and emergency settings with organ failures.
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.
Cureus, 2019
Sheehan's syndrome is hypopituitarism due to pituitary gland necrosis resulting from hemorrhagic shock during pregnancy. It is a rare complication with varied manifestations and a considerable delay in diagnosis. We describe the case of a 36-year-old female with eight years of non-specific symptoms of generalized myalgias and intense fatigue managed symptomatically all these years. Further clinical assessment revealed amenorrhea and agalactia ongoing for several years without a clinical diagnosis. A good history and physical led to the diagnosis during a routine outpatient visit. She had significant improvement noted following the commencement of treatment. Previous case reports describe cases being diagnosed after one or other complications from long-term panhypopituitarism. Through this case, we want to illustrate that undiagnosed Sheehan's syndrome is associated with long-term morbidity, and there should be a high index of suspicion for it to be diagnosed during a routine clinical visit and thus prevent complications before a diagnosis can be made. It is essential to create awareness, especially in developed countries like the United States, where it has received less attention over the last few years.
Annales UMCS, Medicina, 2008
International Journal of Endocrinology, 2018
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 hypopituita...
Indian Journal of Endocrinology and Metabolism, 2011
2020
BACKGROUND AND OBJECTIVES OF THE STUDY Sheehan’s syndrome refers to pituitary ischaemic necrosis due to massive postpartum haemorrhage. It is rarely reported from sub-Saharan Africa despite high incidence of postpartum haemorrhage. The objective of the study was to describe the clinical characteristics of the cases seen by the Endocrinology unit in a tertiary hospital over a period of two years. SUBJECTS, MATERIALS AND METHODS Five cases of Sheehan’s syndrome were seen between March, 2016 and March, 2018. Clinical data was retrieved from the case records and analyzed using SPSSversion 20. RESULTS The age at diagnosis was 36 ± 8.67 years. The median interval between the obstetric haemorrhage and diagnosis was 11 years. Amenorrhoea/oligomenorrhoea, lactation failure, weight loss, excessive tiredness and cold intolerance were found in all the cases. 80% had loss of libido while 60% had loss of hair. 40% had fainting spells. 60% had hypotension. All the patients had anaemia and secondar...
The Journal of the Association of Physicians of India, 2016
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 intrapartum or postpartum haemorrhage. We present an elderly lady with this syndrome who had slowly progressive panhypopituitarism 24 years after a severe haemorrhage associated with the delivery of triplets.
Case Reports in Clinical Medicine, 2013
Sheehan's Syndrome (SS) occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. We report a 41-year-old woman with a history of severe postpartum hemorrhage 18 years prior to presentation. During this period of time, she experienced severe fatigue. Three months prior to being admitted to our hospital, the patient started to notice alopecia, generalized edema and cognitive impairment. After proper investigation, laboratory tests and clinical findings indicated panhypopituitarism. In addition to neuroimaging and past medical history, SS was diagnosed and treatment started. We emphasize the importance of thorough investigation, further diagnosis and management of this condition (especially in third world countries), since SS is a neurological and endocrinological emergency and potentially life threatening.
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