The incidence of postpartum hypopituitarism

Sheehan, H. L.

doi:10.1016/0002-9378(54)90479-2

Cited by 68 publications

(21 citation statements)

References 64 publications

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“…In our study, hypopituitary women with Sheehan's syndrome in whom selective ischaemic damage to the pituitary developed 40 did not have signi®cantly different leptin concentrations compared with women in whom hypopituitarism resulted from pituitary tumour andaor surgery radiotherapy (leptin concentrations 22.4AE 18.8 vs 27.4AE 1.90 ngaml for patients with Sheehan's syndrome and pituitary tumours respectively, P NS). This suggestion does not seem to explain the increased leptin concentrations in hypopituitarism.…”

Section: Discussionmentioning

confidence: 41%

Serum lipid and leptin concentrations in hypopituitary patients with growth hormone deficiency

Özbey

Algün

et al. 2000

Int J Obes

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OBJECTIVE: To investigate the effects of growth hormone (GH) de®ciency on serum lipid and leptin concentrations in hypopituitary patients taking conventional replacement therapy and to determine the relations between leptin and gender and anthropometric and metabolic variables. SUBJECTS: Twenty-one GH de®cient adult hypopituitary patients (15 women, six men) and 21 (14 women, seven men) age, sex and body mass index (BMI) matched healthy controls. MEASUREMENTS: After an overnight fast, anthropometric parameters were measured and body composition was determined by a bioelectrical impedance analyser. Venous blood samples were obtained for the measurements of glucose, total cholesterol, high density lipoprotein (HDL) cholesterol, triglyceride, intact insulin, insulin-like growth factor 1 (IGF-1) and leptin concentrations. Serum leptin and hormones were analysed by radioimmunoassay. RESULTS: Hypopituitary patients with GH de®ciency showed signi®cantly higher triglyceride, total and low density lipoprotein (LDL) cholesterol and lower HDL cholesterol concentrations on conventional replacement therapy. The unfavourable lipid pro®le was particularly evident in women. Signi®cantly higher leptin concentrations were found in patients compared with healthy controls with similar body fat content (23.5 AE 11.8 ngaml vs 11.7 AE 6.9 ngaml, P 0.01). This difference remained signi®cant even when leptin values were expressed in relation to fat mass percentage (0.79 AE 0.40 vs 0.42 AE 0.17 ngaml%, P`0.05) and fat mass kg (1.32 AE 0.81 vs 0.66 AE 0.30 ngaml kg, P`0.05). Signi®cant positive correlations were observed between leptin concentrations and body fat percentage and age in the control group. In patients the sole signi®cant relation between leptin and study parameters was the positive correlation observed between leptin and total cholesterol concentrations. Serum leptin concentrations were signi®cantly higher in women than men in the control group, but not in the patients. No signi®cant gender difference was observed when leptin concentrations were expressed in relation to fat mass (percentage and kg). CONCLUSION: Growth hormone de®cient hypopituitary patients (particularly women) on conventional replacement therapy have a more atherogenic lipid pro®le. Leptin concentrations are increased in GH de®cient adults even after adjustment for percentage body fat and body fat mass (kg). Although the nature of our data does not allow us to draw any conclusions on the mechanism(s) of increased leptin concentrations in GH de®ciency, decreased central sensitivity to leptin and increased leptin production from per unit fat mass, or alterations in leptin clearance, might be operative.

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Section: Discussionmentioning

confidence: 41%

Serum lipid and leptin concentrations in hypopituitary patients with growth hormone deficiency

Özbey

Algün

et al. 2000

Int J Obes

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“…Panhypopituitarism persisted in our case. 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].…”

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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“…The water deprivation test documented diabetes insipidus and response to AVP confirmed central diabetes insipidus. Although SS clinically comes to medical attention with features of anterior pituitary hormone deficiency, interest in the posterior pituitary function has been there since the original description of the disease, when Sheehan noticed atrophic changes in the posterior pituitary (11). Posterior pituitary functions have been tested in many series of patients with SS and subtle defects in AVP secretion have been detected (7)(8)(9)(10).…”

Section: Discussionmentioning

confidence: 99%

“…A role of autoimmunity in the development of hypopituitarism has been suggested. It is believed that tissue necrosis may release sequestered antigens, triggering pituitary autoimmunity and delayed hypopituitarism (3). Most patients present with either complete or partial hypofunction of the anterior pituitary (4-6).…”

mentioning

confidence: 99%

Sheehan's syndrome with central diabetes insipidus

Laway¹,

Mir²,

Dar³

et al. 2011

Arq Bras Endocrinol Metab

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SUMMARYSheehan's syndrome refers to the occurrence of hypopituitarism after delivery, usually preceded by postpartum hemorrhage. The condition still continues to be a common cause of hypopituitarism in developing countries like India. The disorder usually presents with anterior pituitary failure with preservation of posterior pituitary functions. Posterior pituitary dysfunction in the form of central diabetes insipidus is rare in patients with Sheehan's syndrome. We describe the clinical course of a young lady who after her sixth childbirth developed severe postpartum hemorrhage followed by development of panhypopituitarism which was confirmed by hormonal investigation and demonstration of empty sella on imaging. In addition, she developed Polyuria. SUMÁRIOA síndrome de Sheehan está relacionada à ocorrência de hipopituitarismo pós-parto, geralmente precedido por hemorragia pós-parto. Essa condição clínica ainda constitui causa comum do hipopituitarismo observado em países em desenvolvimento como a Índia. Essa síndrome se caracteriza pela insuficiência da glândula hipofisária anterior, porém com a conservação das funções da glândula hipofisária posterior. A disfunção da hipófise posterior, sob a forma de diabetes insipidus central, é algo raramente observado em pacientes que apresentam a síndrome de Sheehan. Neste artigo, descrevemos o caso de uma jovem que, após o sexto parto, apresentou hemorragia pós-parto grave, seguida pela evolução de pan-hipopituitarismo que foi confirmado por pesquisa hormonal e exames de imagem que evidenciaram sela vazia. A jovem também apresentou poliúria. Os resultados do teste de privação de água e exame de resposta à vasopressina indicaram diabetes insípido central. A paciente fazia uso contínuo de desmopressina para controlar a poliúria. Arq Bras Endocrinol Metab. 2011;55(2):171-4 Descritores Síndrome de Sheehan; diabetes insípido central; teste de privação de água

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The incidence of postpartum hypopituitarism

Cited by 68 publications

References 64 publications

Serum lipid and leptin concentrations in hypopituitary patients with growth hormone deficiency

Serum lipid and leptin concentrations in hypopituitary patients with growth hormone deficiency

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

Sheehan's syndrome with central diabetes insipidus

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