scholarly journals Sheehan's Syndrome Presenting with Hyponatraemia: A Case Report

2016 ◽  
Vol 11 (3) ◽  
Author(s):  
Prasanta Kumar Bhattacharya MBBS MD PhD FICP FACP ◽  
Aakash Roy MBBS ◽  
Md. Jamil MBBS MD ◽  
Pranjal Phukan MBBS MD DM ◽  
Kalyan Sarma MBBS
Keyword(s):  
Late Onset ◽  
Post Partum ◽  
Rare Complication ◽  
Pituitary Hormones ◽  
Sheehan’S Syndrome ◽  
Secondary Amenorrhea ◽  
Sheehan Syndrome ◽  
Sheehan's Syndrome ◽  
Psychiatric Manifestations ◽  
Lactational Failure

Sheehan syndrome (SS), or post partum necrosis of the pituitary gland, is a rare complication of post partum haemorrhage usually presenting with failure of lactation and subsequent amenorrhoea. We report a case of a 30-year-old woman with history of secondary amenorrhea and lactational failure following childbirth complicated with severe post partum hemorrhage, who presented to us with anemia, hypotension, acute confusion, neuropsychiatric manifestations, abnormal posturing and severe hyponatraemia. Hormonal assays revealed low pituitary hormones, subnormal levels of cortisol and thyroid hormones, with magnetic resonance imaging of the brain suggestive of SS. Hyponatraemia and late onset neuro-psychiatric manifestations are uncommon presentations of SS. Hence, there should be a high index of clinical suspicion for Sheehan’s syndrome in women with secondary amenorrhea and lactational failure following childbirth, who present with late onset neuro-psychiatric manifestations and hyponatremia.

scholarly journals Co-presentation of Acute Sheehan Syndrome with Raised Intracranial Pressure in a Post-partum Lady

2021 ◽  
pp. 1-3
Author(s):  
Richmond Ronald Gomes ◽  
Keyword(s):  
Intracranial Hypertension ◽  
Postpartum Hemorrhage ◽  
Post Partum ◽  
Rare Complication ◽  
Clinical Manifestations ◽  
Tissue Destruction ◽  
Sheehan’S Syndrome ◽  
Sheehan Syndrome ◽  
Optic Disc Swelling ◽  
Sheehan's Syndrome

Sheehan’s syndrome (SS) or necrosis of pituitary gland is a rare complication of severe postpartum hemorrhage. It may cause hypopituitarism immediately or several years later, depending on the degree of tissue destruction. Sheehan’s syndrome though rare is still one of the commonest causes of hypopituitarism in developing countries like ours. The presence of an intercurrent infection and administration of thyroxine exacerbated her corticosteroid insufficiency. Intracranial hypertension (IH) manifested as bilateral optic disc swelling with reduced visual acuity, bilateral sixth nerve palsies, and impaired consciousness. Intracranial hypertension (IH) has been associated with hypocortisolism caused by either primary adrenocortical insufficiency or corticosteroid withdrawal. The author describes a case of a young lady with IH with acute SS who presented on 3rd day postpartum after lower uterine cesarean section with acute severe symptomatic hyponatremia which was complicated by postpartum hemorrhage. The clinical manifestations of IH resolved with corticosteroid replacement

scholarly journals Diagnosis Delayed but not Denied - Sheehan’s syndrome

2015 ◽  
Vol 53 (197) ◽  
pp. 31-33 ◽  
Author(s):  
Vijayeshree Thyagaraj ◽  
MJ Vinod Kumar
Keyword(s):  
Developing Countries ◽  
Renal Failure ◽  
Postpartum Hemorrhage ◽  
Rare Complication ◽  
Obstetric Care ◽  
Sheehan’S Syndrome ◽  
Sheehan Syndrome ◽  
Life Threatening ◽  
Sheehan's Syndrome ◽  
High Index Of Suspicion

Sheehan’s syndrome is a rare complication of postpartum hemorrhage. With advancement in obstetric care, Sheehan's syndrome has become uncommon except in developing countries. Here, we report a patient with Sheehan’s syndrome who escaped diagnosis for 22 years and presented with life threatening complications. This patient also had certain unusual features of Sheehan’s syndrome like pancytopenia and renal failure. A high index of suspicion is necessary in diagnosing such patients.  Keywords: pancytopenia; renal failure; Sheehan syndrome.  

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 MON-243 Atypical Presentation of Isolated Adrenocorticotropic Hormone Deficiency and Sheehan’s Syndrome

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Zahira Marie Lugo López ◽  
Nadyeschka Angelique Rivera Santana ◽  
Andrea del Toro Diez ◽  
Michelle Marie Mangual Garcia ◽  
Ernesto Sola Sanchez ◽  
...  
Keyword(s):  
Postpartum Hemorrhage ◽  
Adrenocorticotropic Hormone ◽  
Brain Mri ◽  
Pituitary Hormones ◽  
Hormone Deficiency ◽  
Normal Brain ◽  
Sheehan’S Syndrome ◽  
Isolated Acth Deficiency ◽  
Acth Deficiency ◽  
Sheehan's Syndrome

Abstract Introduction: Isolated adrenocorticotropic hormone (ACTH) deficiency is a rare pituitary hormone deficiency defined by secondary adrenal insufficiency and normal secretion of all other pituitary hormones. Patients present with fatigue, weakness, weight loss, anorexia, nausea, low cortisol levels and low ACTH levels. Isolated ACTH deficiency is more common in males and usually presents in the fifth decade of life. Main mechanisms involved in the pathogenesis are genetics and autoimmune causes, traumatic brain injury and infarction of the pituitary postpartum, known as Sheehan’s syndrome. Sheehan’s syndrome is characterized by postpartum hemorrhage, failure to lactate and menstrual irregularities and it can occur from immediate postpartum period to years after delivery. The most common hormone deficiencies are prolactin and growth hormone. Empty sella is the most common finding on brain MRI. We are reporting a case of a woman in her third decade with isolated ACTH deficiency due to Sheehan’s syndrome two years postpartum, able to lactate, with normal menses and normal brain MRI. Clinical Case: A 33-year-old woman G3P3A0 with hypothyroidism who was referred to Endocrinology clinics due to tiredness, fatigue and weakness. She reported postpartum hemorrhage requiring 4 PRBC transfusions and IV steroids after last pregnancy 5 years ago. Patient was able to lactate after pregnancy and continued in her usual state of health until 3 years ago when she referred loss of consciousness with traumatic head injury due to hypoglycemia. At Endocrinology office physical examination and vital signs were unremarkable, including no blood pressure or heart rate variations with positional changes. Despite hypothyroidism being adequately controlled, she continued with extreme fatigue and weakness affecting her quality of life, for which cortisol and ACTH levels were ordered. Laboratories showed normal electrolytes, negative autoantibodies, cortisol 0.20 μg/dL (5-25 μg/dL) and ACTH 22 pg/mL (10-60 pg/mL) suggesting partial isolated ACTH deficiency. ACTH stimulation test was done and noted with suboptimal response. Evaluation of other anterior pituitary hormones was normal. Brain MRI showed normal pituitary gland. She was started on hydrocortisone in AM and PM and symptoms resolved. Conclusion: Immediate recognition of isolated ACTH deficiency due to Sheehan’s syndrome is necessary due to the availability of effective treatment and morbidity and mortality associated with this serious condition. To our knowledge isolated ACTH deficiency due to Sheehan’s syndrome in which the patient was able to lactate and normal findings on brain MRI has not previously been reported.References: Shivaprasad C. Sheehan’s Syndrome: Newer advances. Indian J Endocrinol Metab. 2011 Sep; 15(3): S203-207. DOI:10.4103/2230-8210.84869.

scholarly journals Late-onset Sheehan’s syndrome presenting with rhabdomyolysis and hyponatremia: a case report

2013 ◽  
Vol 7 (1) ◽  
Author(s):  
Maurizio Soresi ◽  
Giuseppe Brunori ◽  
Roberto Citarrella ◽  
Aurelia Banco ◽  
Antonino Zasa ◽  
...  
Keyword(s):  
Case Report ◽  
Late Onset ◽  
Sheehan’S Syndrome ◽  
Sheehan's Syndrome

scholarly journals A rare cause of postpartum acute hyponatremia

2019 ◽  
Vol 2019 ◽  
Author(s):  
Ilan Rahmani Tzvi-Ran ◽  
Judith Olchowski ◽  
Merav Fraenkel ◽  
Asher Bashiri ◽  
Leonid Barski
Keyword(s):  
Urine Analysis ◽  
Post Partum ◽  
Brain Mri ◽  
Thyroid Function Test ◽  
Lymphocytic Hypophysitis ◽  
List Type ◽  
Sheehan’S Syndrome ◽  
Central Hypothyroidism ◽  
Sheehan's Syndrome ◽  
Acute Hyponatremia

Summary A previously healthy 24-year-old female underwent an emergent caesarean section without a major bleeding described. During the first post-operative days (POD) she complained of fatigue, headache and a failure to lactate with no specific and conclusive findings on head CT. On the following days, fever rose with a suspicion of an obstetric surgery-related infection, again with no evidence to support the diagnosis. On POD5 a new-onset hyponatremia was documented. The urine analysis suggested SIADH, and following a treatment failure, further investigation was performed and demonstrated both central hypothyroidism and adrenal insufficiency. The patient was immediately treated with hydrocortisone followed by levothyroxine with a rapid resolution of symptoms and hyponatremia. Further laboratory investigation demonstrated anterior hypopituitarism. The main differential diagnosis was Sheehan’s syndrome vs lymphocytic hypophysitis. Brain MRI was performed as soon as it was available and findings consistent with Sheehan’s syndrome confirmed the diagnosis. Lifelong hormonal replacement therapy was initiated. Further complaints on polyuria and polydipsia have led to a water deprivation testing and the diagnosis of partial central insipidus and appropriate treatment with DDAVP. Learning points: Sheehan’s syndrome can occur, though rarely, without an obvious major post-partum hemorrhage. The syndrome may resemble lymphocytic hypophysitis clinically and imaging studies may be crucial in order to differentiate both conditions. Hypopituitarism presentation may be variable and depends on the specific hormone deficit. Euvolemic hyponatremia workup must include thyroid function test and 08:00 AM cortisol levels.

scholarly journals MON-256 A Late-Onset Case of Sheehan’s Syndrome Presenting as Life Threatening Adrenal Insufficiency

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Salman Zahoor Bhat ◽  
Itivrita Goyal ◽  
Manav Batra
Keyword(s):  
Cortisol Level ◽  
Postpartum Hemorrhage ◽  
Late Onset ◽  
Adrenal Crisis ◽  
High Dose ◽  
Sheehan’S Syndrome ◽  
Number Of Patients ◽  
Patient Reported ◽  
Life Threatening ◽  
Sheehan's Syndrome

Abstract OBJECTIVE Sheehan’s syndrome or postpartum pituitary necrosis, is an important but rare cause of hypopituitarism, caused due to severe postpartum hemorrhage. Seen more commonly in the developing world, it is less common in developed countries due to advanced obstetric practices. It can present acutely but more frequently has an insidious course (onset 10-20 years later) with variable hormonal deficiencies. Here, we report a late-onset case of Sheehan’s syndrome, 24 years after the incident event, presenting as life threatening adrenal failure. CASE PRESENTATION A 48-year-old female with no significant past medical history was admitted to the hospital after being found unresponsive at home. She had not seen a physician for many years. She complained of weakness and lethargy for a week and recently established care with a primary care physician. The patient was severely hypotensive in the emergency department and had an elevated temperature of 101°F. Physical examination showed no significant abnormalities. CBC and metabolic panel were not significantly altered. CSF analysis and CSF/blood cultures were negative for any infection. TSH was 4.29 mIU/mL (0.27-4.20) but the total and free T4 (fT4) were severely low at 1.1 mcg/mL (4.6-12) and 0.24 ng/dL (0.93-1.70) respectively. On further questioning, patient reported severe postpartum hemorrhage 24 years ago, needing multiple units of blood transfusion. This was followed by inability to lactate and menstruate but was never worked up as she had not seen any physician all these years. Pituitary hormonal panel was obtained, demonstrating multiple hormonal deficiencies with fT4 severely low at 0.24 ng/dL, ACTH of 2.6 pg/mL (7.2-63.3), prolactin (PRL) 1 ng/mL (4.8-23.3) and insulin like growth factor-1 (IGF-1) low at 10 ng/mL (56-194). Cortisol level was elevated in the hospital due to administration of high dose IV steroids but a morning cortisol level obtained 1 week prior by her primary was 1.5 mcg/dL (10-20). Estradiol levels were low with FSH and LH levels inappropriately normal. MRI of the pituitary was obtained which showed an empty sella turcica. Patient was diagnosed as late-onset Sheehan’s syndrome. She was started on hormone replacement with hydrocortisone followed by levothyroxine and had marked improvement in her symptoms. She continues to do well. CONCLUSION Our patient presented late due to lack of medical care and awareness. A great number of patients with Sheehan’s diseasae go undiagnosed due to subtle clinical presentations, thus delaying treatment. It is imperative to diagnose this condition timely with appropriate obstetric/gynecological history and clinical suspicion to avoid late manifestations of the disease, especially adrenal crisis. Patients at risk need long term follow-up. Early treatment is necessary to improve quality of life and reduce morbidity and mortality associated with this condition.

scholarly journals A case of Sheehan Syndrome with chronic diffuse muscle pain and weakness

2019 ◽  
Vol 6 (11) ◽  
pp. 310-312
Author(s):  
Erhan Önalan ◽  
Şüheda Ataş ◽  
Kübra Oral
Keyword(s):  
Developing Countries ◽  
Postpartum Hemorrhage ◽  
Empty Sella ◽  
Sheehan’S Syndrome ◽  
Laboratory Findings ◽  
Appropriate Treatment ◽  
Pituitary Deficiency ◽  
Sheehan Syndrome ◽  
History Of ◽  
Sheehan's Syndrome

Objective: Sheehan’s syndrome is pituitary deficiency induced by intrapartum and postpartum hemorrhage and hypovolemia. It is still frequent in underdeveloped and developing countries. Sheehan’s syndrome is one of the reason of empty sella. The symptoms of the syndrome can be seen months to years later depend on the degree of pituitary damage. History of postpartum hemorrhage, failure to lactate and cessation of menses are important  clues to the diagnosis. Early diagnosis and appropriate treatment are very important to reduce morbidity  and mortality of the patients. Case: In this study sheehan’s syndrome which led to auto pan-hypopituitarism and developed gradually in a patient with sheehan‘s syndrome  which in this case, delivered a baby at home 27 years ago and had severe postpartum hemorrhage will be presented. And this 63-year-old female patient was diagnosed as Sjogren’s syndrome and sheehan syndrome by clinical and laboratory findings for the purpose of further investigation and treatment because of symptoms of fever and anemia

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