A novel hook-shaped enhancement on contrast-enhanced sagittal magnetic resonance image in acute Sheehan’s syndrome: a case report

Sasaki, Sho; Fujisawa, Ichiro; Ishihara, Takashi; Tahara, Yoshiro; Kazuma, Mariko; Fujiwara, Yuta; Iwakura, Toshio; Hino, Megumu; Matsuoka, Naoki

doi:10.1507/endocrj.ej13-0280

Cited by 6 publications

(9 citation statements)

References 15 publications

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“…Including our case, marked findings associated with Sheehan’s syndrome have been observed at day 26, day 32, 3 months, 5 months, and 6 months [18, 22, 23, 26]. Specific findings included a non-enhancing, minimally hypointense lesion in the pituitary gland on day 26 postpartum [22] and a hypointense area with a flattened pituitary gland on day 32 postpartum [21].…”

Section: Discussionmentioning

confidence: 88%

“…Appropriate hormonal replacement that is initiated early can improve the clinical status and outcomes of patients.Shoib S2013 [25]3116–18 daysunknownunknownnot describednot describednot describednot describedpsychosisnot describedpossibly hypothyroidismprednisolone and thyroxine sodiumThe treatment to control the bleeding was not described.CT and MRI scans were not performed.Psychosis in patients with Sheehan’s syndrome is uncommon. Clinicians should have a high index of suspicion when postpartum-psychosis presents with a significant obstetric history.Sasaki S2014 [26]374–6 daysretained placentavaginal deliverymassive4.0 g/dLpresentedpresentedfailure to lactatenot describedpanhypopituitarismhydrocortisone.Emergency uterine embolization was performed.Sagittal T1-weighted image showing slight swelling of the anterior lobe and the pituitary stalk (postpartum day 10).At 1 month after delivery, swelling of the anterior lobe was reversed.At 5 months after delivery, marked atrophy of the anterior lobe was observedHale B2014 [27]316 daysretained placentavaginal delivery1500 ml6.2 g/dLpresentedpresentedheadache, failure to lactate, fatiguepresentedpartial hypopituitarismprednisone, levothyroxine, desmopressin and somatropinRetained placenta required manual extraction.Cranial magnetic resonance imaging scan performed on postpartum day six. The pituitary gland appears enlarged with peripheral enhancement and an isodense central area.Postpartum headache is a common occurrence with a broad differential diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies reported that the MRI scans were normal on postpartum day 6; in addition, another study reported that normal scans were obtained on day 19 [20, 21, 24]. Seven studies reported their early MRI findings [11, 13, 17, 19, 22, 23, 26]. Lavallee et al and Dejager et al reported a large intrasellar mass with superior extension was confirmed on T1-weighted on day 6 [11, 13].…”

Section: Discussionmentioning

confidence: 99%

“…Lavallee et al and Dejager et al reported a large intrasellar mass with superior extension was confirmed on T1-weighted on day 6 [11, 13]. Bunch et al, Kaplun et al and Sasaki et al reported an enlarged pituitary gland with an abnormal signal on the T1-weighted pre-contrast images on postpartum day 10, day 10 and day 6, respectively [19, 22, 26]. Anfuso et al described MRI findings from postpartum day 8 that showed an abnormal lack of pituitary gland enhancement [23].…”

Section: Discussionmentioning

confidence: 99%

“…Specific findings included a non-enhancing, minimally hypointense lesion in the pituitary gland on day 26 postpartum [22] and a hypointense area with a flattened pituitary gland on day 32 postpartum [21]. An empty sella was observed several months postpartum [13, 22, 23, 26]. …”

Section: Discussionmentioning

confidence: 99%

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A case of acute Sheehan’s syndrome and literature review: a rare but life-threatening complication of postpartum hemorrhage

Matsuzaki

Endo

Ueda

et al. 2017

BMC Pregnancy Childbirth

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BackgroundSheehan’s syndrome occurs because of severe postpartum hemorrhage causing ischemic pituitary necrosis. Sheehan’s syndrome is a well-known condition that is generally diagnosed several years postpartum. However, acute Sheehan’s syndrome is rare, and clinicians have little exposure to it. It can be life-threatening. There have been no reviews of acute Sheehan’s syndrome and no reports of successful pregnancies after acute Sheehan’s syndrome. We present such a case, and to understand this rare condition, we have reviewed and discussed the literature pertaining to it. An electronic search for acute Sheehan’s syndrome in the literature from January 1990 and May 2014 was performed.Case presentationA 27-year-old woman had massive postpartum hemorrhage (approximately 5000 mL) at her first delivery due to atonic bleeding. She was transfused and treated with uterine embolization, which successfully stopped the bleeding. The postpartum period was uncomplicated through day 7 following the hemorrhage. However, on day 8, the patient had sudden onset of seizures and subsequently became comatose. Laboratory results revealed hypothyroidism, hypoglycemia, hypoprolactinemia, and adrenal insufficiency. Thus, the patient was diagnosed with acute Sheehan’s syndrome. Following treatment with thyroxine and hydrocortisone, her condition improved, and she was discharged on day 24.Her next pregnancy was established 2 years after her first delivery. She required induction of ovulation for the next conception. The pregnancy, delivery, and postpartum period were uneventful. An electronic search of the literature yielded 21 cases of acute Sheehan’s syndrome. Presenting signs varied, including adrenal insufficiency (12 cases), diabetes insipidus (4 cases), hypothyroidism (2 cases), and panhypopituitarism (3 cases), with a median time of presentation after delivery for each of those conditions being 7.9, 4, 18, and 9 days, respectively. Serial changes in magnetic resonance imaging were reported in some cases of acute Sheehan’s syndrome.ConclusionClinicians should be aware of the risk of acute Sheehan’s syndrome after a massive postpartum hemorrhage in order to diagnose it accurately and treat it promptly.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

A case of acute Sheehan’s syndrome and literature review: a rare but life-threatening complication of postpartum hemorrhage

Matsuzaki

Endo

Ueda

et al. 2017

BMC Pregnancy Childbirth

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Visualization of the normal pituitary gland during the endoscopic endonasal removal of pituitary adenoma by narrow band imaging

2016

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Sheehan syndrome

Karaca

Laway

Dökmetaş

et al. 2016

Nat Rev Dis Primers

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Sheehan syndrome or postpartum hypopituitarism is a condition characterized by hypopituitarism due to necrosis of the pituitary gland. The initial insult is caused by massive postpartum haemorrhage (PPH), leading to impaired blood supply to the pituitary gland, which has become enlarged during pregnancy. Small sella turcica size, vasospasms (caused by PPH) and/or thrombosis (associated with pregnancy or coagulation disorders) are predisposing factors; autoimmunity might be involved in the progressive worsening of pituitary functions. Symptoms are caused by a decrease or absence of one or more of the pituitary hormones, and vary, among others, from failure to lactate and nonspecific symptoms (such as fatigue) to severe adrenal crisis. In accordance with the location of hormone-secreting cells relative to the vasculature, the secretion of growth hormone and prolactin is most commonly affected, followed by follicle-stimulating hormone and luteinizing hormone; severe necrosis of the pituitary gland also affects the secretion of thyroid-stimulating hormone and adrenocorticotropic hormone. Symptoms usually become evident years after delivery, but can, in rare cases, develop acutely. The incidence of Sheehan syndrome depends, to a large extent, on the occurrence and management of PPH. Sheehan syndrome is an important cause of hypopituitarism in developing countries, but has become rare in developed countries. Diagnosis is based on clinical manifestations combined with a history of severe PPH; hormone levels and/or stimulation tests can confirm clinical suspicion. Hormone replacement therapy is the only available management option so far.

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A novel hook-shaped enhancement on contrast-enhanced sagittal magnetic resonance image in acute Sheehan’s syndrome: a case report

Cited by 6 publications

References 15 publications

A case of acute Sheehan’s syndrome and literature review: a rare but life-threatening complication of postpartum hemorrhage

A case of acute Sheehan’s syndrome and literature review: a rare but life-threatening complication of postpartum hemorrhage

Visualization of the normal pituitary gland during the endoscopic endonasal removal of pituitary adenoma by narrow band imaging

Sheehan syndrome

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