A Rare Case of Sheehan Syndrome With Cardiac Tamponade

Zain, Ahmer; Sivakumar, Ashwin; Akah, Ozo; Shiza, Saher T; Mahadevaiah, Ashwini; Khan, Aadil

doi:10.7759/cureus.24329

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…Pregnancy-related hypophysitis is another cause of gestation-related pituitary insufficiency, and a recent retrospective analysis identified 148 of such published cases [112]. Additionally, Sheehan syndrome leads to hypopituitarism after a post-partum dramatic event, such as a hemorrhage, due to an obstetric event, and it should be differentiated from PA in PP [34,[113][114][115]. Notably, PA in PP and Sheehan syndrome might be found in women who were otherwise healthy, thus displaying a low index of clinical suspicion [34,[113][114][115].…”

Section: Integrating Pa Amid Other Endocrine Complications Of Pregnancymentioning

confidence: 99%

Challenges of Pituitary Apoplexy in Pregnancy

Gheorghe

Trandafir

Stanciu

et al. 2023

JCM

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Our purpose is to provide new insights concerning the challenges of pituitary apoplexy in pregnancy (PAP) and the postpartum period (PAPP). This is a narrative review of the English literature using a PubMed search. The inclusion criteria were clinically relevant original studies (January 2012–December 2022). Overall, we included 35 original studies: 7 observational studies (selected cases on PA) and 28 case reports, including 4 case series (N = 49; PAP/PAPP = 43/6). The characteristics of PAP patients (N = 43) are as follows: maternal age between 21 and 41 (mean of 27.76) years; 21/43 subjects with a presentation during the third trimester (only one case during first trimester); average weak of gestation of 26.38; most females were prim gravidae; 19 (out of 30 patients with available data on delivery) underwent a cesarean section. Headache remains the main clinical feature and is potentially associated with a heterogeneous panel (including visual anomalies, nausea, vomiting, cranial nerve palsies, diabetes insipidus, photophobia, and neck stiffness). Pre-pregnancy medication included dopamine agonists (15/43) and terguride (1/43) in addition to subsequent insulin therapy for gestational diabetes (N = 2) and type 1 diabetes mellitus (N = 1). Overall, 29/43 females received the conservative approach, and 22/43 women had trans-sphenoidal surgery (TSS) (and 10/22 had the initial approach). Furthermore, 18/43 patients had a pituitary adenoma undiagnosed before pregnancy. Most PA-associated tumors were prolactinomas (N = 26/43), with the majority of them (N = 16/26) being larger than 1 cm. A maternal–fetal deadly outcome is reported in a single case. The characteristics of PAPP patients (N = 6) are as follows: mean age at diagnosis of 33 years; 3/6 subjects had PA during their second pregnancy; the timing of PA varied between 5 min and 12 days after delivery; headache was the main clinical element; 5/6 had no underlying pituitary adenoma; 5/6 patients were managed conservatively and 1/6 underwent TSS; pituitary function recovered (N = 3) or led to persistent hypopituitarism (N = 3). In conclusion, PAP represents a rare, life-threatening condition. Headache is the most frequent presentation, and its prompt distinction from other conditions associated with headache, such as preeclampsia and meningitis, is essential. The index of suspicion should be high, especially in patients with additional risk factors such as pre-gestation treatment with dopamine agonists, diabetes mellitus, anticoagulation therapy, or large pituitary tumors. The management is conservative in most cases, and it mainly includes corticosteroid substitution and dopamine agonists. The most frequent surgical indication is neuro-ophthalmological deterioration, although the actual risk of pituitary surgery during pregnancy remains unknown. PAPP is exceptionally reported. To our knowledge, this sample–case series study is the largest of its kind that is meant to increase the awareness to the benefit of the maternal–fetal outcomes from multidisciplinary insights.

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Section: Integrating Pa Amid Other Endocrine Complications Of Pregnancymentioning

confidence: 99%

Challenges of Pituitary Apoplexy in Pregnancy

Gheorghe

Trandafir

Stanciu

et al. 2023

JCM

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“…Sheehan's syndrome (SS) is primarily caused by ischemic pituitary necrosis due to hemorrhage related to childbirth that results in reduced perfusion of the pituitary [1,2]. Patients with SS frequently experience secondary hypothyroidism and adrenal insufficiency [3].…”

Section: Introductionmentioning

confidence: 99%

Sheehan’s Syndrome in a Fifty-Six-Year-Old Woman Presenting With a Retroperitoneal Mass: Perioperative Management During a Major Surgery

Naguib

2023

J Endocrinol Metab

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Patients with Sheehan's syndrome (SS) can present with adrenal crisis, myxedema coma, hypoglycemia, and hyponatremia, which could be triggered by an infection or surgery. For the endocrinologist, a patient with SS who is scheduled for surgery presents a significant challenge as more likely to experience delayed emergence from anesthesia, hypotension that does not respond to the standard regimen, a decrease in core body temperature, and a decreased need for anesthetic drugs due to reduced metabolism. Here, to emphasize the significance of perioperative management to reduce the risk of morbidity and mortality from a potential adrenal crisis, we report the successful perioperative management of a 56-year-old woman with SS undergoing major surgery for the resection of a retroperitoneal tumor. The management plan for this patient comprised a perioperative intravenous hydrocortisone supplementation and thyroxine tablets on the morning of the procedure. In the operating room, the patient was started on norepinephrine, and she was given intravenous (IV) crystalloids and albumin. Healthcare providers should be aware of the perioperative risk of SS. No consensus, guidelines, or randomized trials for the safe perioperative management of patients with SS have been identified by a thorough review of the literature. Because of this, the perioperative care of these patients necessitates the utmost caution in addition to successful management based on close coordination between the endocrinologist, surgeon, and anesthetist.

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Actuación de enfermería ante el Síndrome de Sheehan en pacientes: una revisión bibliográfica

Espinoza Loja

2024

rgn

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Se busca determinar la prevalencia y los factores de riesgo del Síndrome de Sheehan, así como explorar los abordajes terapéuticos, identificar complicaciones frecuentes y evaluar intervenciones de enfermería. Se efectuó una revisión de 50 artículos seleccionados por su relevancia. La prevalencia registrada es de 14 millones de casos de hemorragia posparto anualmente, con una incidencia global del Síndrome de Sheehan de 1 en 100,000 nacimientos. El embarazo y la subsiguiente hemorragia posparto se presentan como los principales factores precipitantes. El tratamiento eficaz requiere un reemplazo hormonal permanente. Las complicaciones clave incluyen la agalactia, la amenorrea y el hipopituitarismo. Las intervenciones de enfermería se centran en el manejo de los síntomas y la implementación del Proceso de Atención de Enfermería (PAE). La hemorragia posparto que excede los 1000 ml de pérdida sanguínea, con una reposición insuficiente de volumen, es un antecedente común en las pacientes con el síndrome de Sheehan.

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A Rare Case of Sheehan Syndrome With Cardiac Tamponade

Cited by 3 publications

References 10 publications

Challenges of Pituitary Apoplexy in Pregnancy

Challenges of Pituitary Apoplexy in Pregnancy

Sheehan’s Syndrome in a Fifty-Six-Year-Old Woman Presenting With a Retroperitoneal Mass: Perioperative Management During a Major Surgery

Actuación de enfermería ante el Síndrome de Sheehan en pacientes: una revisión bibliográfica

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