Sheehan syndrome: acute presentation with severe headache

Hale, Betsy; Habib, Ashraf S.

doi:10.1016/j.ijoa.2014.04.011

Cited by 10 publications

(12 citation statements)

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“…Twenty cases of acute Sheehan’s syndrome were published in international peer-reviewed literature. The 21 cases are summarized in Table 2 [9–27]. We selected the topics, which are distinct features of acute Sheehan’s syndrome for further discussion.…”

Section: Discussionmentioning

confidence: 99%

“…Appropriate hormonal replacement that is initiated early can improve the clinical status and outcomes of patients.Shoib S2013 [25]3116–18 daysunknownunknownnot describednot describednot describednot describedpsychosisnot describedpossibly hypothyroidismprednisolone and thyroxine sodiumThe treatment to control the bleeding was not described.CT and MRI scans were not performed.Psychosis in patients with Sheehan’s syndrome is uncommon. Clinicians should have a high index of suspicion when postpartum-psychosis presents with a significant obstetric history.Sasaki S2014 [26]374–6 daysretained placentavaginal deliverymassive4.0 g/dLpresentedpresentedfailure to lactatenot describedpanhypopituitarismhydrocortisone.Emergency uterine embolization was performed.Sagittal T1-weighted image showing slight swelling of the anterior lobe and the pituitary stalk (postpartum day 10).At 1 month after delivery, swelling of the anterior lobe was reversed.At 5 months after delivery, marked atrophy of the anterior lobe was observedHale B2014 [27]316 daysretained placentavaginal delivery1500 ml6.2 g/dLpresentedpresentedheadache, failure to lactate, fatiguepresentedpartial hypopituitarismprednisone, levothyroxine, desmopressin and somatropinRetained placenta required manual extraction.Cranial magnetic resonance imaging scan performed on postpartum day six. The pituitary gland appears enlarged with peripheral enhancement and an isodense central area.Postpartum headache is a common occurrence with a broad differential diagnosis.…”

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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“…The third case, complicated by postpartum hemorrhage and hypotension, was diagnosed on postpartum day 6 after readmission because of intense headache, agalactia, dizziness, fatigue, nausea, and vomiting. 9 In this case, a brain MR with gadolinium contrast revealed findings consistent with pituitary infarction that ultimately led to a diagnosis of SS.…”

Section: Discussionmentioning

confidence: 75%

“…The literature reports three cases of SS presenting with headache. [8][9][10] In one case, the patient presented 5 hours postpartum after an episode of severe hypotension. 8 The other two cases reported initial presentations with headache 8 hours postdelivery secondary to postpartum hemorrhage in one case and after a delivery complicated by both hypotension and postpartum hemorrhage in the other case.…”

Section: Discussionmentioning

confidence: 99%

“…8 The other two cases reported initial presentations with headache 8 hours postdelivery secondary to postpartum hemorrhage in one case and after a delivery complicated by both hypotension and postpartum hemorrhage in the other case. 9,10 In the first two instances, SS was not considered until patients presented with agalactia and other endocrine symptoms. The third case, complicated by postpartum hemorrhage and hypotension, was diagnosed on postpartum day 6 after readmission because of intense headache, agalactia, dizziness, fatigue, nausea, and vomiting.…”

Section: Discussionmentioning

confidence: 99%

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Sheehan Syndrome: An Unusual Presentation Without Inciting Factors

Sethuram

Guilfoil

Amori

et al. 2020

Women's Health Reports

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Background: Sheehan syndrome (SS) is a rare complication of severe postpartum hemorrhage or hypotension during the processes of labor and delivery that results in ischemic pituitary infarction and necrosis. In this case report, we describe an unusual presentation of SS without inciting factors. Case Presentation: A 30-year-old multiparous woman presented 2 hours after a normal spontaneous vaginal delivery with a profound severe headache, and subsequent agalactia, dry skin, and mood changes. She was managed conservatively until 10 months postdelivery when she complained of persistent symptoms including amenorrhea. A brain magnetic resonance (MR) with pituitary imaging revealed findings consistent with SS. The patient's symptoms improved and ultimately resolved after levothyroxine, estrogen replacement therapy, and hydrocortisone were instituted. Conclusions: SS can present without recognized inciting factors. During the initial phase, women may present with profound headache and/or visual disturbances warranting neurological evaluation. A high index of suspicion and a brain MR with pituitary imaging should prompt early consideration of SS to aid in the diagnosis.

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