Sheehan's Syndrome of More Than 30 Years' Duration: An Endocrine and MRI Study of 6 Cases.

Otsuka, Fumio; Kageyama, Jingo; Ogura, Toshio; Hattori, Teruhiko; Makino, Hírofumi

doi:10.1507/endocrj.45.451

Cited by 29 publications

(27 citation statements)

References 23 publications

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“…The pituitary stalk usually survives after hypovolemia in Sheehan's syndrome that is because there is rich blood supply from the superior/inferior hypophyseal and the trabecular arteries [13]. Lymphocytic adenohypophysitis, an autoimmune disease of the anterior pituitary gland, is often observed after delivery and causes postpartum panhypopituitarism ending up in empty sella, the same as Sheehan's syndrome in chronic phase [14][15][16][17]. In acute phase, as we have described previously, lymphocytic adenohypophysitis shows a homogenous enhancement in the anterior lobe in typical MR image [14,15].…”

Section: Discussionmentioning

confidence: 99%

A novel hook-shaped enhancement on contrast-enhanced sagittal magnetic resonance image in acute Sheehan’s syndrome: a case report

et al. 2014

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Section: Discussionmentioning

confidence: 99%

A novel hook-shaped enhancement on contrast-enhanced sagittal magnetic resonance image in acute Sheehan’s syndrome: a case report

et al. 2014

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“…2 Pituitary imaging studies late in the course have revealed atrophy of the gland, resulting in a small empty sella. 3,4 Rarely, patients present with pituitary apoplexy. 2 MR imaging studies have been reported in only a few cases.…”

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confidence: 99%

Sequential Pituitary MR Imaging in Sheehan Syndrome: Report of 2 Cases

Kaplun

Fratila²,

Ferenczi³

et al. 2008

AJNR Am J Neuroradiol

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SUMMARY:We present the evolution of pituitary changes in the cases of 2 patients with Sheehan syndrome as assessed by MR imaging. Both patients had severe postpartum hemorrhage, symptoms of pituitary gland apoplexy, and hypopituitarism. Sequential MR imaging demonstrated evidence of ischemic infarct in the pituitary gland with enlargement followed by gradual shrinkage during several months, to pituitary atrophy. Clinical recognition of Sheehan syndrome (hypopituitarism resulting from postpartum pituitary gland infarction after severe hypotension secondary to massive bleeding 1 ) is often insidious, with the diagnosis being delayed for years. 2Pituitary imaging studies late in the course have revealed atrophy of the gland, resulting in a small empty sella. 3,4 Rarely, patients present with pituitary apoplexy.2 MR imaging studies have been reported in only a few cases. 5,6 We report the cases of 2 patients with Sheehan syndrome with acute presentations, in which the progression of pituitary gland changes was assessed by sequential MR imaging. Case Reports Case 1A 29-year-old woman delivered a full-term baby. The delivery was complicated by retained placenta and profuse bleeding, requiring emergent embolization of the uterine artery. Her hemoglobin level fell to 3.8 g/dL. Several hours later, the patient developed a severe headache and nausea. A routine CT study of her head showed no abnormality. Her symptoms resolved, and she was discharged from the hospital without additional work-up. She returned on day 17 postpartum with fatigue, fever, mild headache, failure to lactate, and postural syncope. Her temperature was 101.2°F, pulse 122, and a supine blood pressure of 90/48 mm Hg. Examination showed skin pallor, a cardiac flow murmur, clear lungs, and a soft abdomen. Laboratory evaluation revealed anemia, mild hyponatremia (sodium, 134 mEq/L), and abnormal pituitary function test results (Table) consistent with panhypopituitarism.MR imaging on postpartum day 26 (Fig 1) revealed a nonenhancing, minimally hypointense lesion in the pituitary gland. MR imaging 6 months postpartum (Fig 2) showed shrinkage of the pituitary gland with CSF signal intensity in the sella ("empty sella"). The pituitary infundibulum and hypothalamus appeared normal. Case 2A 21-year-old woman delivered a full-term healthy baby after labor was induced following premature rupture of membranes. During delivery, she sustained a fourth-degree perineal laceration with severe bleeding and hypotension (blood pressure, 60/30 mm Hg). Her he-

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“…Acute hypopituitarism in the context of obstetric haemorrhage, as described initially by Sheehan in 1937 (37), refers to ischaemic pituitary infarction occurring as an immediate response to an obstetric haemodynamic insult. Two recent Japanese reports collectively described a total of seven cases of complete or partial hypopituitarism (with an empty sella on MRI) 3-48 years after massive obstetric blood loss (38,39). Our observations indicate that a significantly fatigued patient with a history of postpartum haemorrhage, significant gastrointestinal blood loss or shock requiring transfusion or intensive-care support should be carefully evaluated for underlying pituitary deficiency, irrespective of when the haemorrhage occurred relative to presentation.…”

Section: Discussionmentioning

confidence: 62%

Evaluation of pituitary function in the fatigued patient: a review of 59 cases

Greenfield

Samaras²

2006

eur j endocrinol

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Objective: The aim of this study was to review the results of dynamic pituitary testing in patients presenting with fatigue. Methods: We reviewed clinical histories and insulin tolerance test (ITT) results of 59 patients who presented with fatigue and other symptoms of glucocorticoid insufficiency over a 4-year period. All patients referred for ITT had an early-morning cortisol level of ,400 nM and a low or normal ACTH level. Results: Peak cortisol and GH responses following insulin-induced hypoglycaemia were normal in only seven patients (12%). Median age of the remaining 52 patients was 47 years (range, 17-67 years); all but five were female. Common presenting symptoms were neuroglycopaenia (n ¼ 47), depression (n ¼ 37), arthralgia and myalgia (n ¼ 28), weight gain (n ¼ 25), weight loss (n ¼ 9), postural dizziness (n ¼ 15) and headaches (n ¼ 13). Other medical history included autoimmune disease (n ¼ 20; particularly Hashimoto's thyroiditis, Graves' disease and coeliac disease), postpartum (n ¼ 8) and gastrointestinal (n ¼ 2) haemorrhage and hyperprolactinaemia (n ¼ 13). 31 subjects had peak cortisol levels of , 500 nM (suggestive of ACTH deficiency; 18 of whom had levels , 400 nM) and a further six had indeterminate results (500 -550 nM). The remaining 15 subjects had normal cortisol responses (median 654 nM; range, 553-1062 nM) but had low GH levels following hypoglycaemic stimulation (5.9 mU/l; 3-11.6 mU/l). Conclusion: Our results suggest that patients presenting with fatigue and symptoms suggestive of hypocortisolism should be considered for screening for secondary adrenal insufficiency, particularly in the presence of autoimmune disease or a history of postpartum or gastrointestinal haemorrhage. Whether physiological glucocorticoid replacement improves symptoms in this patient group is yet to be established. European Journal of Endocrinology 154 147-157

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Sheehan's Syndrome of More Than 30 Years' Duration: An Endocrine and MRI Study of 6 Cases.

Cited by 29 publications

References 23 publications

A novel hook-shaped enhancement on contrast-enhanced sagittal magnetic resonance image in acute Sheehan’s syndrome: a case report

A novel hook-shaped enhancement on contrast-enhanced sagittal magnetic resonance image in acute Sheehan’s syndrome: a case report

Sequential Pituitary MR Imaging in Sheehan Syndrome: Report of 2 Cases

Evaluation of pituitary function in the fatigued patient: a review of 59 cases

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