Sheehan′s syndrome co-existing with Graves′ disease

Arpacı, Dilek; Çuhacı, Neslihan; Sağlam, Fatma; Ersoy, Reyhan; Çakır, Bekir

doi:10.4103/1119-3077.141447

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…[ 17 ] A third report described cases of concomitant Graves' disease and Sheehan's syndrome. [ 18 ] A more recent report described that a subject with known panhypopitutarism developed thyrotoxicosis that contributed to acute glucocorticoid deficiency. [ 19 ] Another report showed that it was possible for hyperthyroidism secondary to toxic thyroid nodule, to occur with hypopituitarism.…”

Section: Discussionmentioning

confidence: 99%

Multiple Fractures in Patient with Graves' Disease Accompanied by Isolated Hypogonadotropic Hypogonadism

Kim

et al. 2016

J Bone Metab

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Isolated hypogonadotropic hypogonadism (IHH) is known to decrease bone mineral density due to deficiency of sex steroid hormone. Graves' disease is also an important cause of secondary osteoporosis. However, IHH does not preclude the development of primary hyperthyroidism caused by Graves' disease, leading to more severe osteoporosis rapidly. Here, we describe the first case of 35-year-old Asian female patient with IHH accompanied by Graves' disease and osteoporosis-induced multiple fractures. Endocrine laboratory findings revealed preserved anterior pituitary functions except for secretion of gonadotropins and showed primary hyperthyroidism with positive autoantibodies. Sella magnetic resonance imaging showed slightly small sized pituitary gland without mass lesion. Dual energy X-ray absorptiometry revealed severe osteoporosis in lumbar spine and femur neck of the patient. Plain film radiography of the pelvis and shoulder revealed a displaced and nondisplaced fracture, respectively. After surgical fixation with screws for the femoral fracture, the patient was treated with antithyroid medication, calcium, and vitamin D until now and has been recovering fairly well. We report a patient of IHH with Graves' disease and multiple fractures that is a first case in Korea.

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Section: Discussionmentioning

confidence: 99%

Multiple Fractures in Patient with Graves' Disease Accompanied by Isolated Hypogonadotropic Hypogonadism

Kim

et al. 2016

J Bone Metab

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“…Finally, concurrent Sheehan’s syndrome and GD in the postpartum has been reported (51). In this case report, GD appeared first and Sheehan’s syndrome later.…”

Section: Postpartum Thyroid Autoimmunitymentioning

confidence: 99%

Autoimmune Abnormalities of Postpartum Thyroid Diseases

et al. 2017

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The year following parturition is a critical time for the de novo appearance or exacerbation of autoimmune diseases, including autoimmune thyroid disease. The vast majority of postpartum thyroid disease consists of postpartum thyroiditis (PPT) and the minority by Graves’ disease and non-autoimmune thyroiditis. PPT has a worldwide prevalence ranging from 1 to 22% and averaging 5% based on a review published in 2012. Several factors confer risk for the development of PPT. Typically, the clinical course of PPT is characterized by three phases: thyrotoxic, hypothyroid, and euthyroid phase. Approximately half of PPT women will have permanent hypothyroidism. The best humoral marker for predictivity, already during the first trimester of gestation, is considered positivity for thyroperoxidase autoantibodies (TPOAb), though only one-third to half of such TPOAb-positive pregnant women will develop PPT. Nutraceuticals (such as selenium) or omega-3-fatty acid supplements seem to have a role in prevention of PPT. In a recent study on pregnant women with stable dietary habits, we found that the fish consumers had lower rates of positivity (and lower serum levels) of both TPOAb and thyroglobulin Ab compared to meat eaters. Finally, we remind the reader of other diseases that can be observed in the postpartum period, either autoimmune or non-autoimmune, thyroid or non-thyroid.

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“…In literature, we found some case reports regarding the association between GD and central hypothyroidism. The etiology of central hypothyroidism in the reported cases was craniopharyngioma ( 30 , 31 ), Sheehan’s syndrome ( 32 , 33 ), hypothalamic tumor ( 34 ), pituitary macroadenoma ( 35 ), surgical resection of a pituitary lesion ( 36 ), and radiation therapy to a nasopharyngeal tumor with pituitary invasion ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

Prolactin-Producing Pituitary Carcinoma, Hypopituitarism, and Graves’ Disease—Report of a Challenging Case and Literature Review

et al. 2018

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IntroductionThe diagnosis of pituitary carcinoma is very rare, requires the evidence of metastatic disease, and has a poor overall survival. Malignant prolactinoma frequently requires dopamine agonist therapy, pituitary surgery, radiotherapy, and even chemotherapy.Case descriptionA 19-year-old female presented with galactorrhea, primary amenorrhea, and left hemianopsia. Complementary study detected hyperprolactinemia and a pituitary macroadenoma with cavernous sinus invasion and suprasellar growth. She was treated with cabergoline and bromocriptine without clinical or analytical improvement. Resection of the pituitary lesion was programmed and a non-contiguous lesion of the nasal mucosa was detected during the approach. This metastasis led to the diagnosis of prolactin-producing pituitary carcinoma. After partial resection, the patient was submitted to radiotherapy for residual disease with persistent symptoms. She developed growth hormone deficiency, central hypothyroidism, hypogonadism, and permanent diabetes insipidus. Six years later she was admitted for the suspicion of secondary adrenal insufficiency and thyrotoxicosis. Physical findings, laboratory data, thyroid ultrasound, and scintigraphy achieved the diagnosis of Graves’ disease and hypocortisolism. She was treated with hydrocortisone and methimazole, but central hypothyroidism recurred after antithyroid drug withdrawal. Nine years after the diagnosis of a pituitary carcinoma, she maintains treatment with bromocriptine, has a locally stable disease, with no metastases.ConclusionThis report highlights an unusual presentation of a prolactin-producing pituitary carcinoma in a young female. The patient had multiple hormone deficiencies due to a pituitary lesion and treatments. The posterior development of hyperthyroidism and adrenal insufficiency brought an additional difficulty to the approach.

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Sheehan′s syndrome co-existing with Graves′ disease

Cited by 3 publications

References 20 publications

Multiple Fractures in Patient with Graves' Disease Accompanied by Isolated Hypogonadotropic Hypogonadism

Multiple Fractures in Patient with Graves' Disease Accompanied by Isolated Hypogonadotropic Hypogonadism

Autoimmune Abnormalities of Postpartum Thyroid Diseases

Prolactin-Producing Pituitary Carcinoma, Hypopituitarism, and Graves’ Disease—Report of a Challenging Case and Literature Review

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