Sheehan's syndrome in Saudi Arabia

Banzal, Subodh; Ayoola, E. Ayobanji

doi:10.1016/s0020-7292(99)00065-x

Cited by 14 publications

(17 citation statements)

References 4 publications

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“…Sheehan’s syndrome is pituitary necrosis after PPH and hypovolemia and occurs in 1–2% of women who lose 1–2 L of blood with associated hypotension [5, 6]. Several studies have shown that the latent period between symptoms and postpartum hemorrhage can be several years in Sheehan’s syndrome [2, 4, 7]. For example, in 1999, Banzal et al reported significant delays between symptom onset and postpartum hemorrhage, with only two patients diagnosed within a year, 20 patients that were symptomatic for over 6 years before diagnosis, and appropriate treatment [7].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that the latent period between symptoms and postpartum hemorrhage can be several years in Sheehan’s syndrome [2, 4, 7]. For example, in 1999, Banzal et al reported significant delays between symptom onset and postpartum hemorrhage, with only two patients diagnosed within a year, 20 patients that were symptomatic for over 6 years before diagnosis, and appropriate treatment [7]. Symptoms that first occur within 6 weeks postpartum are defined as acute Sheehan’s syndrome in this report because the postpartum period is commonly identified as 6 weeks after delivery.…”

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: 99%

Section: Discussionmentioning

confidence: 99%

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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“…3,16 A diagnostic delay of more than ten years was seen in 10 of our patients, which is higher than the numbers reported by Banzal et al (27%). 6 Decade long diagnostic delay is most probably due to the vague symptoms of asthenia seen in 50% of our patients and poor access to health care. This diagnostic delay can lead to life threatening presentations such as metabolic encephalopathy and secondary adrenal crisis as occurred in nearly a quarter of our patients.…”

Section: Discussionmentioning

confidence: 90%

“…18 Thyrotropin and corticotropin deficiency was documented in all our patients which was similar to that reported by Sert et al 4 In the background of multiple pituitary hormone deficiencies with amenorrhea, inappropriately normal levels of LH and FSH are suggestive of central hypogonadism, and were seen in all of our patients similar to that reported in other studies. 5,6 GH and PRL levels were available in 4 and 8 patients respectively and all values were below the reference range. GH and PRL deficiency has been documented in all the patients reported in two other studies.…”

Section: Discussionmentioning

confidence: 99%

“…3 Growth hormone (GH) and prolactin (PRL) involvement is seen in 90%-100% of the patients; whereas, involvement of gonadotrophs, thyrotrophs and corticotrophs may be seen in 50%-100% of the patients. [4][5][6] GH deficiency is very common in SS as somatotrophs, located in the lower and lateral regions of the pituitary, are most likely to be damaged by ischaemic necrosis of pituitary. 7 Half a century ago, the prevalence of SS was 10-20 per 100,000 women.…”

Section: Introductionmentioning

confidence: 99%

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Sheehan's syndrome: A single centre experience

Sunil¹,

Rajita²,

Rajagopal³

et al. 2013

JCSR

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Background: Sheehan's syndrome (SS) occurs as a result of ischaemic pituitary necrosis due to severe postpartum haemorrhage. It is one of the most common causes of hypopituitarism in developing countries. Objective: To study the clinical profile of patients with SS presenting to the Endocrinology Department at a tertiary care teaching hospital in South India. Methods: All patients diagnosed as SS during the study period of 2007-2012 were identified. Their clinical, biochemical, hormonal, radiological and bone mineral density (BMD) data were collected. Results: Eighteen patients were identified. Median age of diagnosis was 40 years [interquartile range (IQR = 32-51years); median (IQR) diagnostic delay was 11 (5-17 years)]. Failure to resume menstruation and lactation failure was the most common clinical presentation. The median total tetraiodothyronine (T4), peak stimulated cortisol, stimulated growth hormone (GH), and prolactin (PRL) levels were low. The gonadotropins [follicle stimulating hormone (FSH) and luteinizing hormone (LH)] were inappropriately normal in the presence of amenorrhea. Hyponatremia was the most common electrolyte abnormality seen in 14 patients. Seven patients had anaemia and five of them had normocytic normochromic anaemia. BMD assessment (n = 9) was suggestive of low bone mass.

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