Posterior pituitary function in Sheehan’s syndrome

Atmaca, Hulusi; Tanrıverdi, Fatih; Gökçe, Cumali; Ünlühızarcı, Kürşad; Keleştimur, Fahrettin

doi:10.1530/eje-06-0727

Cited by 45 publications

(32 citation statements)

References 17 publications

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“…Although clinically manifest diabetes insipidus is uncommon in SS, the frequency of partial diabetes insipidus was found to be 29.6% in SS patients who did not have polyuria (28). In that study the osmotic threshold for the onset of thirst in patients with SS was found to be increased.…”

Section: Discussionmentioning

confidence: 74%

Extensive investigation of 114 patients with Sheehan's syndrome: a continuing disorder

Diri

Tanrıverdi

Karaca

et al. 2014

European Journal of Endocrinology

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Objective: 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. Study design: 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. Results: 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 whose basal prolactin was below 4.0 ng/ml had adequate prolactin responses to TRH test, while all patients whose basal prolactin was above 7.8 ng/ml had adequate responses. Mean sella volume was found to be significantly lower in the SS group (340.5G214 mm 3 ) than that in the healthy group (602.5G192 mm 3 ). Conclusions: SS is a common cause of hypopituitarism in underdeveloped and developing countries. The main reasons for diagnostic delay seem to be the high frequency of patients with nonspecific complaints and neglect of SS. In addition, the TRH stimulation test was found to have a high sensitivity and specificity to recognize PRL deficiency. Furthermore, small sella size may have an important contributing role in the etiopathogenesis of SS.

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Section: Discussionmentioning

confidence: 74%

Extensive investigation of 114 patients with Sheehan's syndrome: a continuing disorder

Diri

Tanrıverdi

Karaca

et al. 2014

European Journal of Endocrinology

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“…We further evaluated causes of hypopituitarism and considered only cases where posterior pituitary damage was likely. 30,31 The following cases were excluded: subclinical hypopituitarism (n ¼ 16); 4,6,8,11 -13,17,19,25,28,29 cause of hypopituitarism not specified (n ¼ 1); 21 first-trimester miscarriages (n ¼ 15). 1,4,12,19 Sixteen case reports 3,5-7,9,10,14 -16,18,20,22-24,26,27 describing the outcome of 18 pregnancies and one trial 1 reporting 13 pregnancies in nine women were included in the analysis.…”

Section: Methodsmentioning

confidence: 99%

High-risk pregnancy management in women with hypopituitarism

et al. 2009

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Pregnancy after complete loss of pituitary function is uncommon. However, advances in fertility treatment have led to increased pregnancy rates in hypopituitary women. We hereby present a literature review of pregnancies affected by hypopituitarism, including a comparison with published controls; further, we add one case report of severe hypopituitarism where third-trimester oxytocin supplementation was performed. As only limited information is available on management and outcome, our purpose was to determine obstetric complications associated with deficiency of pituitary hormones. The analysis of 31 pregnancies in 27 women revealed that hypopituitary women are at increased risk: postpartum hemorrhage occurred in 8.7%, transverse lie in 16%; 42.4% of the newborns were small for gestational age. These findings are supposedly the result of uterine dysfunction caused by hormone deficiency. Oxytocin supplementation was performed with the aim to establish physiologic conditions and to prevent postpartum uterine inertia. In this case substitution may have contributed to correct fetal presentation but did not prevent postpartum hemorrhage. Further investigations into both oxytocin-dependent and -independent mechanisms regulating uterine contractions and contractility are necessary to develop strategies for prevention of uterine inertia in oxytocin-deficient pregnancies.

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“…None of the patients in the present se ries had involvement of posterior pituitary function in the form of polyuria. Diabetes insipidus is quite rare in these patients, though subtle features of posterior pituitary involvement have been reported (23). Table 3 summarizes the anterior pituitary involvement in re ported series of patients with SS.…”

Section: Discussionmentioning

confidence: 99%

Clinical, hormonal and radiological features of partial Sheehan’s syndrome: an Indian experience

Laway

Misgar

Mir

et al. 2016

Arch. Endocrinol. Metab.

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Objective: The objective of this study was to describe clinical presentation, hormonal profile and imaging characteristics of 21 patients with partial Sheehan's syndrome. Subjects and methods: This prospective study was carried out over a period of six years (2008)(2009)(2010)(2011)(2012)(2013). The evaluation of patients included clinical assessment, hormone estimations and contrast enhanced magnetic resonance imaging of pituitary. Results: We documented preservation of gonadotroph, corticotroph and lactotroph function in 71.4, 61.9, and 9.5% of patients respectively. Conclusion: To conclude some of the pituitary functions can be preserved in Sheehan's syndrome and this has important implications from the treatment and long term morbidity point of view. Arch Endocrinol Metab. 2016;60(2):125-9

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Posterior pituitary function in Sheehan’s syndrome

Cited by 45 publications

References 17 publications

Extensive investigation of 114 patients with Sheehan's syndrome: a continuing disorder

Extensive investigation of 114 patients with Sheehan's syndrome: a continuing disorder

High-risk pregnancy management in women with hypopituitarism

Clinical, hormonal and radiological features of partial Sheehan’s syndrome: an Indian experience

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