Acute aortic dissection associated with Sheehan’s syndrome

Abstract

A 69-year-old woman with Sheehan's syndrome who suffered acute Stanford type A aortic dissection had received corticosteroids and thyroid hormones for over 20 years. The entire ascending aorta was replaced in emergency graft replacement. We administered twice the usual dose of methylprednisolone during cardiopulmonary bypass and twice the patient's usual dose of prednisolone from postoperative day 1 to 6. The usual 100 micrograms of levothyroxine sodium was given orally from postoperative day 1. The patient's postoperative course was uneventful. This case emphasizes the importance of early active supplementary treatment with steroids and thyroid hormones for major surgery in patients with Sheehan's syndrome.

The Effects of Hypothyroidism on the Mechanical Properties and Histomorphological Structure of the Thoracic Aorta

“…43,44 A possible association between hypothyroidism and aortic pathologies, such as aortic dissection and aortic aneurysm formation, has been investigated by some authors, emphasizing a possible contribution of hypothyroidism on the mechanical performance of the aorta. [4][5][6][7][8] Various mechanisms have been proposed to elucidate and explain this possible association, as progression of atherosclerosis, disturbance of the mechanical properties (hardening of aorta), altered mucopolysaccharide turnover leading to weakening of the aortic wall, and damage of the aortic wall due to autoimmune mechanisms. [4][5][6][7][8] Niarchos suggested a possible association between hypothyroidism and abdominal aortic aneurysm formation based on the observation that among 26 cases with myxedema, 4 cases had an aortic aneurysm.…”

“…[4][5][6][7][8] Various mechanisms have been proposed to elucidate and explain this possible association, as progression of atherosclerosis, disturbance of the mechanical properties (hardening of aorta), altered mucopolysaccharide turnover leading to weakening of the aortic wall, and damage of the aortic wall due to autoimmune mechanisms. [4][5][6][7][8] Niarchos suggested a possible association between hypothyroidism and abdominal aortic aneurysm formation based on the observation that among 26 cases with myxedema, 4 cases had an aortic aneurysm. 5 In addition, single cases describing instances of aortic aneurysm formation in long-standing hypothyroidism have been reported.…”

“…3 Clinical studies have suggested a possible association between hypothyroidism and aortic pathology such as aortic dissection and aortic aneurysm formation. [4][5][6][7][8][9][10] These studies were based on the effects of hypothyroidism on aortic wall structure, while there are no data investigating the mechanical performance of aorta, although it is well known that the mechanical properties determine its fundamental hemodynamic role. Due to its mechanical properties, the aorta acts both as a conduit and as an elastic chamber, distending with blood during cardiac contraction and discharging blood through the peripheral vasculature by elastic recoil while the heart refills.…”