scholarly journals Anti-hypothalamus and anti-pituitary antibodies may contribute to perpetuate the hypopituitarism in patients with Sheehan's syndrome

2008 ◽  
Vol 158 (2) ◽  
pp. 147-152 ◽  
Author(s):  
Annamaria De Bellis ◽  
Fahrettin Kelestimur ◽  
Antonio Agostino Sinisi ◽  
Giuseppe Ruocco ◽  
Gilda Tirelli ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Autoimmune Process ◽  
Sheehan’S Syndrome ◽  
Immunofluorescence Method ◽  
Pituitary Dysfunction ◽  
Hypothalamic Cells ◽  
Duration Of Disease ◽  
Sheehan's Syndrome ◽  
Pituitary Antibodies

ObjectiveWhile anti-pituitary antibodies (APAs) were detected in some patients with Sheehan's syndrome (SS) suggesting an autoimmune pituitary involvement in the development of their hypopituitarism, hypothalamic cell anti-hypothalamus antibodies (AHAs) have not been investigated so far.DesignThe aim of this study was to evaluate the presence of AHA and APA in SS patients to verify whether an autoimmune hypothalamic–pituitary process can contribute to their late hypopituitarism.MethodsTwenty women with SS with a duration of disease ranging from 3 to 40 years (median 25.5 years) were enrolled into the study. Out of 20 patients, 12 (60%) had panhypopituitarism and the others had partial hypopituitarism well corrected with appropriate replacement therapy. None of them had clinical central diabetes insipidus. AHA and APA were investigated by immunofluorescence method in all patients. In addition, a four-layer immunofluorescence method was used to verify whether AHA immunostained vasopressin-secreting cells (AVP-c) or not.ResultsAHAs were found in 8 out of 20 (40%) and APAs in 7 out of 20 (35%) patients with titers ranging from 1:32 to 1:128 and 1:16 to 1:32 respectively; however, in none of these positive patients AHA immunostained vasopressin cells. None of controls resulted positive for both antibodies.ConclusionsPatients with SS, even many years after the onset of SS, can show antibodies to pituitary and/or hypothalamic but not AVP-secreting cells. Antibodies to unknown hypothalamic cells (releasing factor-secreting cells) other than APAs suggest that an autoimmune process involving both the hypothalamus and pituitary gland may contribute to late pituitary dysfunction in SS patients.

scholarly journals Sheehan's syndrome with central diabetes insipidus

2011 ◽  
Vol 55 (2) ◽  
pp. 171-174 ◽  
Author(s):  
Bashir Ahmad Laway ◽  
Shahnaz Ahmad Mir ◽  
Mohd Iqbal Dar ◽  
Abdul Hamid Zargar
Keyword(s):  
Diabetes Insipidus ◽  
Postpartum Hemorrhage ◽  
Clinical Course ◽  
Empty Sella ◽  
Central Diabetes Insipidus ◽  
Posterior Pituitary ◽  
Test Results ◽  
Sheehan’S Syndrome ◽  
Pituitary Dysfunction ◽  
Sheehan's Syndrome

Sheehan'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. The water deprivation test and response to vasopressin test results indicated central diabetes insipidus. She needed oral desmopressin on a continuous basis to control polyuria.

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

scholarly journals Sheehan’s Syndrome Revisited: Underlying Autoimmunity or Hypoperfusion?

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
José Gerardo González-González ◽  
Omar David Borjas-Almaguer ◽  
Alejandro Salcido-Montenegro ◽  
René Rodríguez-Guajardo ◽  
Anasofia Elizondo-Plazas ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Diagnostic Criteria ◽  
Postpartum Hemorrhage ◽  
Hypovolemic Shock ◽  
Sheehan’S Syndrome ◽  
History Of ◽  
Sheehan's Syndrome ◽  
Pituitary Antibodies

Sheehan’s syndrome remains a frequent obstetric complication with an uncertain pathophysiology. We aimed to assess the incidence of hypopituitarism (≥2 hormonal axis impairment) within the first six postchildbirth months and to determine the existence of anti-pituitary antibodies. From 2015 to 2017, adult pregnant women, who developed moderate to severe postpartum hemorrhage (PPH), were consecutively included in the study. Pituitary function was assessed 4 and 24 weeks after PPH. At the end of the study, anti-pituitary antibodies were assessed. Twenty women completed the study. Mean age was 26.35 (±5.83) years. The main etiology for severe PPH was uterine atony (65%) which resulted mostly in hypovolemic shock grades III-IV. Within the first four weeks after delivery, 95% of patients had at least one hormonal pituitary affected and 60% of the patients fulfilled diagnostic criteria for hypopituitarism. At the end of the study period, five patients (25%) were diagnosed with hypopituitarism (GH and cortisol axes affected). Anti-pituitary antibodies were negative in all patients. At 6 months follow-up, one in every four women with a history of moderate-to-severe PPH was found with asymptomatic nonautoimmune-mediated hypopituitarism. The role of autoimmunity in Sheehan’s syndrome remains uncertain. Further studies are needed to improve the remaining knowledge gaps.

scholarly journals Reversible cardiomyopathy as a rare presentation of sheehan’s syndrome-case report and review of literature

2017 ◽  
Vol 4 (6) ◽  
pp. 1713 ◽  
Author(s):  
Mohmmad Hayat Bhat ◽  
Farhana Bagdadi ◽  
Asma Rafi ◽  
Parvaiz Ahmad Shah
Keyword(s):  
Pituitary Gland ◽  
Post Partum ◽  
Hormone Replacement ◽  
Poor Response ◽  
Sheehan’S Syndrome ◽  
Rare Presentation ◽  
Sheehan's Syndrome ◽  
Post Partum Period ◽  
Pressure Changes ◽  
High Degree

Sheehan’s syndrome is a clinical condition characterised by post-partum panhypopitutarism caused by necrosis of the pituitary gland. The hypervascularity of the pituitary gland during pregnancy makes it vulnerable to arterial pressure changes and prone to haemorrhage in the post-partum period. The cardinal features are lethargy, secondary amenorrhea and lactational failure. The diagnosis in immediate post-partum period is difficult and require a high degree of suspicion. Cardiac involvement in sheehan’s syndrome is known but rare.We hereby present a case of post-partum cardiomyopathy with relatively poor response to anti failure treatment. Patient however responded to hormone replacement including glucocorticoids and levothyroxine, after proper confirmation of the hypopituitary state. Cardiac dysfunction markedly reversed with the institution of replacement therapy.

scholarly journals Sheehan's Syndrome and Diabetes Insipidus

BMJ ◽  
1963 ◽  
Vol 1 (5346) ◽  
pp. 1679-1679
Author(s):  
J. C. Sloper
Keyword(s):  
Diabetes Insipidus ◽  
Sheehan’S Syndrome ◽  
Sheehan's Syndrome

scholarly journals Acute Sheehan's syndrome presenting as central diabetes insipidus

2012 ◽  
Vol 2012 (nov06 1) ◽  
pp. bcr2012007022-bcr2012007022 ◽  
Author(s):  
R. Robalo ◽  
C. Pedroso ◽  
A. Agapito ◽  
A. Borges
Keyword(s):  
Diabetes Insipidus ◽  
Central Diabetes Insipidus ◽  
Sheehan’S Syndrome ◽  
Sheehan's Syndrome

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.

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