scholarly journals Acute Sheehan’s syndrome manifesting initially with diabetes insipidus postpartum: a case report and systematic literature review

2021 ◽  
Author(s):  
Gregor Leonhard Olmes ◽  
Erich-Franz Solomayer ◽  
Julia Caroline Radosa ◽  
Panagiotis Sklavounos ◽  
Philipp Agne ◽  
...  
Keyword(s):  
Systematic Review ◽  
Literature Review ◽  
Diabetes Insipidus ◽  
Case Reports ◽  
Hormone Replacement ◽  
Disease Onset ◽  
Brain Magnetic Resonance Imaging ◽  
Pituitary Hormone ◽  
Sheehan’S Syndrome ◽  
Sheehan's Syndrome

Abstract Purpose Acute Sheehan’s syndrome is a rare, but potentially life-threatening, obstetric event that can be complicated by diabetes insipidus. Little information on the diagnosis and treatment of Sheehan’s syndrome with diabetes insipidus is available. We report on a 28-year-old patient who developed acute Sheehan’s syndrome with diabetes insipidus after giving birth, and on a systematic review of similar cases. Methods We performed a systematic review of the literature cataloged in PubMed and Google Scholar using the keywords “Sheehan syndrome” OR “Sheehan's syndrome” AND “diabetes insipidus” to identify relevant case reports published between 1990 and 2021. Eight Reports met the inclusion criteria (English-language abstracts available, onset in the puerperium, information about the day of the onset). Results In the present case, postpartum curettage was necessary to remove the residual placenta. The total amount of blood loss was severe (2500 ml). On the second day postpartal, the patient developed polyuria. Laboratory analysis revealed hypernatremia with increased serum osmolality and decreased urinary osmolality. Hormone analysis showed partial hypopituitarism involving the thyroid, corticotropic, and gonadotropic axes. The prolactin level was elevated. Brain magnetic resonance imaging showed pituitary gland infarction. Desmopressin therapy was initiated and resolved the polyuria. Hormone replacement therapy was administered. Four months later, the patient was well, with partial diabetes insipidus. The literature review indicated that this case was typical in terms of symptoms and disease onset. Most reported cases involve hypotension and peripartum hemorrhage, but some patients without hemorrhage also develop Sheehan’s syndrome. Elevated prolactin levels are uncommon and associated with poor prognosis in patients with Sheehan’s syndrome. Conclusion Acute Sheehan’s syndrome with diabetes insipidus involves nearly all pituitary hormone axes, indicating severe disease. Prolactin elevation could suggest that a case of Sheehan’s syndrome is severe.

scholarly journals SUN-279 A Rare Case of Atypical Rhaboid Teratoid Tumour with Germinoma Differentiation in a 59 Year Old Woman

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Melissa-Rosina Pasqua ◽  
Huda Altoukhi ◽  
Valerie Panet-Raymond ◽  
Denis Sirhan ◽  
Jason Karamchandani ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Case Reports ◽  
Hormone Replacement ◽  
Sella Turcica ◽  
Proliferation Index ◽  
Pituitary Hormone ◽  
Malignant Tumours ◽  
Rhabdoid Tumour ◽  
Mixed Features ◽  
Atypical Teratoid

Abstract Atypical teratoid/rhabdoid tumours (ATRT) are a rare class of central nervous system malignant tumours which are comprised of elements of ectoderm and mesoderm germ-cell layers, but exhibit microscopic similarity to skeletal muscle. These tumours are more commonly seen in pediatric patients, with few case reports recently describing adult patients with this condition, in particular middle-aged women.1–3 We present the case of a previously healthy 59-year-old woman who was found incidentally to have a pituitary mass on CT head, with retrospective symptoms of headaches, polyuria, polydipsia, diplopia, and low blood pressure. At presentation, she was found biochemically to have pan-hypopituitarism with a left cranial nerve six deficit, with an MRI depicting a 19.5 x 22 x 11 mm suprasellar mass extending into the infundibulum and hypothalamus, with displacement of the optic chiasm; repeat imaging ruled out apoplexy. She was started on supplemental levothyroxine and hydrocortisone replacement therapy, and sent for urgent transsphenoidal resection, which was complicated afterwards by hypernatremia from diabetes insipidus. Preliminary reports were suggestive of germinoma given the diffuse presence of Oct 3/4 and C-kit, with a proliferation index of 99%; further cytology of lumbar puncture revealed no malignant cells. However, upon further pathological analysis, her tumour demonstrated loss of INI-1 expression, which is diagnostic of ATRT. Given the mixed features on immunohistochemistry, the final diagnosis was concluded as an atypical teratoid/rhabdoid tumour of the sella turcica with germinoma differentiation. A multi-disciplinary approach consisted of initial radiotherapy, with chemotherapy targeted towards a germinoma-type tumour, and pituitary hormone replacement including treatment for central diabetes insipidus. This represents a unique case of a rare tumour with germinoma differentiation in an older patient that has not been previously reported. References 1. Journal of Clinical Neuroscience 49 (2018) 16–21 2. Acta Neurochir (Wien) (2008) 150: 491–496 3. Surgical Neurology International 2014, 5:75

scholarly journals A 45-year-old female patient with Sheehan’s syndrome presenting with imminent adrenal crisis: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Abere Genetu ◽  
Yibeltal Anemen ◽  
Sinshaw Abay ◽  
Simachew Anemen Bante ◽  
Kebadnew Mulatu Mihrete
Keyword(s):  
Case Reports ◽  
Rare Complication ◽  
Hormone Replacement ◽  
Delayed Diagnosis ◽  
Obstetric Care ◽  
Adrenal Crisis ◽  
Sheehan’S Syndrome ◽  
Delay In Diagnosis ◽  
Sheehan's Syndrome

Abstract Background Sheehan's syndrome is hypopituitarism due to pituitary gland necrosis resulting from hemorrhagic shock during pregnancy. It is a rare complication with varied manifestations and a considerable delay in diagnosis. Case presentation We describe the case of a 45-year-old Ethiopian woman who presented with generalized fatigue for 18 years which progressed to anorexia, nausea, vomiting, diarrhea, and abdominal pain of 6 years' duration, for which she was treated symptomatically throughout these years. Complete clinical evaluation, endocrine studies, and pituitary magnetic resonance scan revealed hypopituitarism secondary to Sheehan’s syndrome. She had significant improvement noted following the commencement of hormone replacement therapy. Conclusion Previous case reports describe patients being diagnosed after one or more complications from long-term panhypopituitarism. The present case illustrates that undiagnosed Sheehan's syndrome is associated with long-term morbidity, and we want to emphasize that a high index of suspicion is crucial for the early diagnosis of the syndrome in routine clinical visits in order to prevent complications arising with delayed diagnosis. Awareness among clinicians is also essential so that such cases are not overlooked, especially in developing nations, where home delivery is still common and obstetric care is limited.

Reticular erythematous mucinosis: Literature review and case report of a 24-year-old patient with systemic erythematosus lupus

Lupus ◽  
2020 ◽  
pp. 096120332096570
Author(s):  
Juliana P Ocanha-Xavier ◽  
Camila O Cola-Senra ◽  
Jose Candido C Xavier-Junior
Keyword(s):  
Systematic Review ◽  
Case Report ◽  
Literature Review ◽  
English Language ◽  
Case Reports ◽  
Histopathological Diagnosis ◽  
Skin Disorders ◽  
Histopathological Findings ◽  
Inflammatory Skin

Reticular erythematous mucinosis (REM) was first described 50 years ago, but only around 100 case reports in English have been published. Its relation with other inflammatory skin disorders is still being debated. We report a case of REM, including the clinical and histopathological findings. Also, a systematic review of 94 English-language reported cases is provided. The described criteria for clinical and histopathological diagnosis are highlighted in order to REM can be confidently diagnosed.

scholarly journals Applicability of Moyers analysis in mixed dentition: A systematic review

2013 ◽  
Vol 18 (6) ◽  
pp. 100-105 ◽  
Author(s):  
Mariana de Aguiar Bulhões Galvão ◽  
Gladys Cristina Dominguez ◽  
Sérgio Thomaz Tormin ◽  
Alex Akamine ◽  
André Tortamano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Literature Review ◽  
Clinical Case ◽  
Case Reports ◽  
Mixed Dentition ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Theoretical Probability ◽  
Study Population ◽  
Mixed Dentition Analysis

INTRODUCTION: Moyers analysis is widely used for analyzing mixed dentition, however, the accuracy of its theoretical probability tables has been recently questioned. Taking into consideration the fact the mixed dentition analysis is of paramount importance to precisely determine the space needed for alignment of canines and premolars, this research aimed at objectively assessing in the literature such an important step for orthodontic diagnosis. METHODS: A computerized search involving articles published on PubMed and Lilacs between 1990 and September, 2011 was conducted in accordance with the method described in the Cochrane 5.1.0 handbook. RESULTS: The research resulted in a sample composed of 629 articles. The inclusion criteria were: Articles using the Moyers analysis with a sample greater or equal to 40 patients. Conversely, the exclusion criteria were: Dental casts of patients with syndromes or oral cleft, researches conducted with a literature review, only, or clinical case reports and researches conducted before 1990. For this systematic review, 19 articles were selected. CONCLUSION: Based on the literature available, we can conclude that the Moyers mixed dentition analysis must be carefully used, since the majority of the articles analyzed showed that the probability of 75% was not as accurate as expected, leading to the need of adapting the probability levels depending on the study population.

Misleading normal TSH and persistently elevated creatine kinase: clues to the diagnosis of chronic Sheehan’s syndrome

2021 ◽  
Vol 14 (8) ◽  
pp. e243992
Author(s):  
Ayşe Y Demir ◽  
Christine P Oldenburg-Ligtenberg ◽  
Bianca Loredana Toma-Stan ◽  
Albert van de Wiel
Keyword(s):  
Creatine Kinase ◽  
Postpartum Haemorrhage ◽  
Hormone Replacement ◽  
Sella Turcica ◽  
Reference Interval ◽  
Thyroid Stimulating Hormone ◽  
Empty Sella ◽  
Sheehan’S Syndrome ◽  
Elevated Creatine Kinase ◽  
Sheehan's Syndrome

A 53-year-old woman was referred for medical evaluation of therapy-resistant dyslipidaemia accompanied by elevated creatine kinase levels. Because cessation or alteration of her medication did not improve laboratory abnormalities, hypothyroidism was considered, despite the fact that thyroid stimulating hormone levels were within the reference interval. On further evaluation, she was found to have panhypopituitarism and empty sella turcica as shown by MRI. These findings were unexpected since there was no clinical suspicion during detailed evaluation. When supplementary questions were asked, she brought up a history of severe postpartum haemorrhage 30 years ago, for which she underwent a hysterectomy. Based on these findings, the patient was diagnosed with Sheehan’s syndrome. This syndrome is a rare but potentially life-threatening complication of postpartum haemorrhage, characterised by varying degrees of hypopituitarism that are most commonly presented many years after delivery. The patient recovered after adequate hormone replacement therapy.

A Case of Sheehan's Syndrome Presenting Central Diabetes Insipidus

2006 ◽  
Vol 21 (4) ◽  
pp. 333
Author(s):  
Dong Jin Kim ◽  
Nan Hee Kim ◽  
Ju Ri Park ◽  
Sae Jeong Yang ◽  
Hye Suk Kim ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Central Diabetes Insipidus ◽  
Sheehan’S Syndrome ◽  
Sheehan's Syndrome

Pituitary failure from Sheehan's syndrome in the puerperium. Two case reports

1987 ◽  
Vol 94 (10) ◽  
pp. 998-999 ◽  
Author(s):  
A. A. LAKHDAR ◽  
E. H. MCLAREN ◽  
N. S. DAVDA ◽  
E. J. MCKAY ◽  
P. C. RUBIN
Keyword(s):  
Case Reports ◽  
Sheehan’S Syndrome ◽  
Sheehan's Syndrome

scholarly journals Etiopathogenesis of Sheehan’s Syndrome: Roles of Coagulation Factors and TNF-Alpha

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Halit Diri ◽  
Elif Funda Sener ◽  
Fahri Bayram ◽  
Nazife Tascioglu ◽  
Yasin Simsek ◽  
...  
Keyword(s):  
Gene Polymorphisms ◽  
Venous Blood ◽  
Hormone Deficiency ◽  
Control Group ◽  
Pituitary Hormone ◽  
Factor V ◽  
Sheehan’S Syndrome ◽  
Factor Ii ◽  
Sheehan's Syndrome ◽  
Pai 1

Sheehan’s Syndrome (SS) is defined as pituitary hormone deficiency due to ischemic infarction of the pituitary gland as a result of massive postpartum uterine hemorrhage. Herein, we aimed to investigate the roles ofFactor II(G20210A),Factor V(G1691A),MTHFR(C677T and A1298C),PAI-14G/5G, andTNF-α(-308  G>A) gene polymorphisms in the etiopathogenesis of SS. Venous blood samples were obtained from 53 cases with SS and 43 healthy women. Standard methods were used to extract the genomic DNAs.Factor II(G20210A),Factor V(G1691A), andMTHFR(C677T and A1298C) polymorphisms were identified by real-time PCR.PAI-14G/5G andTNF-α(-308  G>A) gene polymorphisms were detected with polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) methods. According to statistical analysis, none of the polymorphisms were found to be significantly higher in the SS group compared to the control group. Hence, we suggest that genetic factors other thanFactor II, Factor V, MTHFR, PAI-1, andTNF-αgene polymorphisms should be researched in the etiopathogenesis of SS.

scholarly journals Characteristics of COVID-19 recurrence: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Tung Hoang
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Meta Analysis ◽  
Disease Onset ◽  
Case Series ◽  
Final Analysis ◽  
Disease Recurrence ◽  
Pooled Prevalence ◽  
Epidemiological Characteristics

AbstractBackgroundPrevious studies reported the recurrence of coronavirus disease 2019 (COVID-19) among discharge patients. This study aimed to examine the characteristic of COVID-19 recurrence cases by performing a systematic review and meta-analysis.MethodsA systematic search was performed in PubMed and Embase and gray literature up to September 17, 2020. A random-effects model was applied to obtain the pooled prevalence of disease recurrence among recovered patients and the prevalence of subjects underlying comorbidity among recurrence cases. The other characteristics were calculated based on the summary data of individual studies.ResultsA total of 41 studies were included in the final analysis, we have described the epidemiological characteristics of COVID-19 recurrence cases. Of 3,644 patients recovering from COVID-19 and being discharged, an estimate of 15% (95% CI, 12% to 19%) patients was re-positive with SARS-CoV-2 during the follow-up. This proportion was 14% (95% CI, 11% to 17%) for China and 31% (95% CI, 26% to 37%) for Korea. Among recurrence cases, it was estimated 39% (95% CI, 31% to 48%) subjects underlying at least one comorbidity. The estimates for times from disease onset to admission, from admission to discharge, and from discharge to RNA positive conversion were 4.8, 16.4, and 10.4 days, respectively.ConclusionThis study summarized up-to-date evidence from case reports, case series, and observational studies for the characteristic of COVID-19 recurrence cases after discharge. It is recommended to pay attention to follow-up patients after discharge, even if they have been in quarantine.

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