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Urhan E, Karaca Z. Diagnosis of hypoprolactinemia. Rev Endocr Metab Disord 2024:10.1007/s11154-024-09896-8. [PMID: 39037546 DOI: 10.1007/s11154-024-09896-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Abstract
Prolactin is a polypeptide hormone composed of 199 amino acids, synthesized by lactotroph cells. Its primary effects are on the mammary gland and gonadal axes, but it also influences different organs and systems, particularly metabolic functions. Current literature has mainly focused on the diagnosis, monitoring, and treatment of hyperprolactinemia. Due to the lack of a well-established effective treatment for hypoprolactinemia, it is not clinically emphasized. Therefore, data on its diagnosis is limited. Hypoprolactinemia has been associated with metabolic dysfunctions such as type 2 diabetes mellitus, fatty liver, dyslipidemia, fertility problems, sexual dysfunction, and increased cardiovascular disease. While often seen as a part of combined hormone deficiencies due to pituitary damage, isolated prolactin deficiency is rare. Hypoprolactinemia can serve as a marker for extensive pituitary gland damage and dysfunction.Low or undetectable serum prolactin levels and the absence of a sufficient prolactin peak in the thyrotropin-releasing hormone (TRH) stimulation test are considered diagnostic for hypoprolactinemia. Gender appears to influence both basal prolactin levels and TRH stimulation test responses. Basal prolactin levels of, at least, 5 ng/mL for males and 7 ng/mL for females can be used as cut-off levels for normal prolactin reserve. Minimum peak prolactin responses of 18 ng/mL for males and 41 ng/mL for females to TRH stimulation can exclude hypoprolactinemia. However, larger population studies across different age groups and sexes are needed to better define normal basal prolactin levels and prolactin responses to the TRH stimulation test.
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Affiliation(s)
- Emre Urhan
- Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey
| | - Zuleyha Karaca
- Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey.
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2
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Sheng B, Jiang G, Ni J. Association between postpartum depression and postpartum hemorrhage: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2024; 103:1263-1270. [PMID: 38475881 PMCID: PMC11168283 DOI: 10.1111/aogs.14795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Postpartum depression (PPD) is a growing mental health concern worldwide and has detrimental effects on the social and cognitive health of both mothers and infants. This review was performed to assess the risk of PPD in women with postpartum hemorrhage (PPH) and to identify potential moderators. MATERIAL AND METHODS The review protocol was registered in the PROSPERO database on June 17, 2023 (registration number: CRD42023432955). Two researchers independently performed a literature search of the PubMed, Embase, and Web of Science databases for articles published before May 25, 2023, with no filters and no language or location restrictions. Study quality was evaluated using the Newcastle-Ottawa Scale. The primary outcome was the odds ratio (OR) and 95% confidence interval (CI) of PPD in women with vs. without PPH. We performed sensitivity analyses and meta-regression analyses to resolve heterogeneity. Meta-regression analyses included the effects of age, maternal smoking, marital status, preterm labor, maternal education level, preeclampsia, anemia during pregnancy, and cesarean section. RESULTS In total, seven studies involving 540 558 participants met the eligibility criteria and were included in the meta-analysis. Women with PPH were at increased risk of PPD compared with women without PPH (OR 1.10; 95% CI 1.03-1.16), and heterogeneity was low (I2 = 23%; τ2 = 0.0007; p = 0.25). Moreover, the results of the sensitivity analyses showed that the I2 value decreased from 23% to 0% after excluding one particular study, which may have been a source of heterogeneity. In the meta-regression analyses, the OR of PPD was greatly affected by maternal smoking (OR -0.26; 95% CI -0.30 to -0.22; p < 0.001). However, we did not observe any effects for maternal age, marital status, preterm labor, maternal education level, preeclampsia, anemia during pregnancy, or cesarean section. CONCLUSIONS Women with PPH must be closely monitored because they have a higher risk of PPD than women without PPH. Early recognition and management of these patients will improve treatment outcomes, maternal health, and newborn development.
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Affiliation(s)
- Bo Sheng
- Department of AnesthesiologyWest China Second University Hospital, Sichuan UniversityCity of ChengduSichuanChina
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of EducationSichuan UniversityCity of ChengduSichuanChina
| | - Guoguo Jiang
- Department of Hospital Infection ManagementThe Second Hospital of Chengdu CityCity of ChengduSichuanChina
| | - Juan Ni
- Department of AnesthesiologyWest China Second University Hospital, Sichuan UniversityCity of ChengduSichuanChina
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of EducationSichuan UniversityCity of ChengduSichuanChina
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Ghosh J, Dharamdasani S, Parthan G, Shah R, Dutta P. Sheehan's Syndrome in a Patient With Factor XI Deficiency. Cureus 2024; 16:e62328. [PMID: 39006713 PMCID: PMC11246184 DOI: 10.7759/cureus.62328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
Sheehan's syndrome (SS) is a condition characterized by panhypopituitarism that generally occurs after an episode of postpartum bleeding. There are certain hypotheses regarding the development of SS in the postpartum period. Coagulation factor abnormalities have been reported to be associated with SS. Associated hypothyroidism and hypocortisolism have been found to cause coagulation abnormalities. After the correction of the hypothyroidism and hypocortisolism, there is a gradual correction of the coagulation abnormality. In our case, a middle-aged woman presented with recurrent episodes of hospital admission because of generalized weakness and fever. She was found to have a biochemistry profile suggestive of hypopituitarism with preserved gonadal function. Her hemogram was normal, but the coagulogram showed a prolongation of activated partial thromboplastin time with a near-normal prothrombin time. She was evaluated and found to have factor XI deficiency. In the background of excessive vaginal bleeding and hypopituitarism, a diagnosis of SS was made. The presence of factor XI deficiency may have led to excessive bleeding and the development of SS. To the best of our knowledge, there is no reported association of factor XI deficiency with SS in the literature, and this is the first reported case.
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Affiliation(s)
- Jayaditya Ghosh
- Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | | | | | - Ravi Shah
- Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Pinaki Dutta
- Endocrinology, Postgraduate Institute of Medical Education and Research, Ahmedabad, IND
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Corsello A, Paragliola RM, Salvatori R. Diagnosing and treating the elderly individual with hypopituitarism. Rev Endocr Metab Disord 2024; 25:575-597. [PMID: 38150092 DOI: 10.1007/s11154-023-09870-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 12/28/2023]
Abstract
Hypopituitarism in the elderly is an underestimated condition mainly due to the non-specific presentation that can be attributed to the effects of aging and the presence of comorbidities. Diagnosis and treatment of hypopituitarism often represent a challenging task and this is even more significant in the elderly. Diagnosis can be insidious due to the physiological changes occurring with aging that complicate the interpretation of hormonal investigations, and the need to avoid some provocative tests that carry higher risks of side effects in this population. Treatment of hypopituitarism has generally the goal to replace the hormonal deficiencies to restore a physiological balance as close as possible to that of healthy individuals but in the elderly this must be balanced with the risks of over-replacement and worsening of comorbidities. Moreover, the benefit of some hormonal replacement therapies in the elderly, including sex hormones and growth hormone, remains controversial.
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Affiliation(s)
- Andrea Corsello
- Unità di Chirurgia Endocrina, Ospedale Isola Tiberina - Gemelli Isola, 00186, Rome, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Rosa Maria Paragliola
- Unicamillus-Saint Camillus International University of Health Sciences, 00131, Rome, Italy
| | - Roberto Salvatori
- Division of Endocrinology, Department of Medicine, and Pituitary Center, Johns Hopkins University, Baltimore, MD, 2187, USA.
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Uzun I, Karaca Z, Hacioğlu A, Unluhizarci K, Kelestimur F. The diagnosis and prevalence of hypoprolactinemia in patients with panhypopituitarism and the effects on depression and sexual functions. Pituitary 2024; 27:277-286. [PMID: 38700812 DOI: 10.1007/s11102-024-01393-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE We aimed to investigate the prevalence and the diagnostic criteria of hypoprolactinemia in patients with panhypopituitarism and the effects of hypoprolactinemia on depression and sexual functions. MATERIALS AND METHODS Forty-eight patients with panhypopituitarism and 20 healthy volunteers were included. Basal hormone levels were measured and a TRH stimulation test was performed. For the evaluation of sexual functions, questionnaries of Female Sexual Functional Index (FSFI) for females and International Erectile Functional Index for males were performed to the subjects. Depressive symptoms were evaluated by Beck Depression Envontory score (BDI-II). RESULTS The peak PRL response to TRH stimulation test at 5th percentile in the control group was 18.6 ng/ml in males and 41.6 ng/ml in females and accepted as the cut-offs for sufficient response of PRL. Prolactin was insufficient in 42(87.5%) patients. A basal PRL level of ≤ 5.7 ng/ml in males and 7.11 ng/ml in females was 100% specific in predicting an inadequate response to TRH stimulation test with 80% and 70% sensitivity respectively. A basal PRL level of ≥ 8.5 ng/dl in males was 100% specific and 76% sensitive, and in females a level of ≥ 15.2 ng/dl was 96% specific and 66% sensitive in predicting an adequate response to TRH. PRL deficient patients with panhypopituitarism had higher depression scores compared to the controls, lower sexual function scores in males. CONCLUSION PRL deficiency is prevalent among individuals with panhypopituitarism, with the potential to result in elevated depression scores in both sexes and impaired sexual functions in males. A basal PRL level seems to be sufficient for the diagnosis of hypoprolactinemia in routine clinical practice.
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Affiliation(s)
- Ilknur Uzun
- Faculty of Medicine, Department of Endocrinology, Erciyes University, Kayseri, Turkey
| | - Zuleyha Karaca
- Faculty of Medicine, Department of Endocrinology, Erciyes University, Kayseri, Turkey.
| | - Aysa Hacioğlu
- Faculty of Medicine, Department of Endocrinology, Erciyes University, Kayseri, Turkey
| | - Kursad Unluhizarci
- Faculty of Medicine, Department of Endocrinology, Erciyes University, Kayseri, Turkey
| | - Fahrettin Kelestimur
- Faculty of Medicine, Department of Endocrinology, Yeditepe University, İstanbul, Turkey
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Manrique-Castaño S, Rodríguez-Rosero L, Vallejo-Serna R. A Case Report of Hemolytic Hyponatremia. Cureus 2024; 16:e53417. [PMID: 38435165 PMCID: PMC10908413 DOI: 10.7759/cureus.53417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Hereditary spherocytosis/elliptocytosis is a non-immune hemolytic anemia caused by an alteration in the erythrocyte membrane that predisposes the cell to its lysis. This report presents a case of a 42-year-old woman with a history of spontaneous abortion, associated with postpartum bleeding, chronic anemia, and premature menopause. After five years, she consulted due to alterations in the state of consciousness and severe symptomatic hyponatremia, with a diagnosis of hypopituitarism, explained by a late Sheehan syndrome. During hospitalization, she developed non-immune hemolytic anemia associated with a positive osmotic fragility test. A diagnosis of hereditary spherocytosis/elliptocytosis was made. We correlate blood hypoosmolarity as a trigger with the in vitro hypotonic solution of the osmotic fragility test for the diagnosis of this disease. This association is not reported in the literature; in our case, we show the concomitant improvement of anemia with the increase in sodium levels and hormonal replacement.
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Affiliation(s)
| | - Luisa Rodríguez-Rosero
- Internal Medicine, Hospital Universitario del Valle "Evaristo García" - Universidad del Valle, Cali, COL
| | - Raúl Vallejo-Serna
- Internal Medicine, Hospital Universitario del Valle "Evaristo García" - Universidad del Valle, Cali, COL
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Occhiali E. Acute Sheehan syndrome revealed by neuropsychiatric disorders. Int J Obstet Anesth 2024; 57:103965. [PMID: 38158252 DOI: 10.1016/j.ijoa.2023.103965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Emilie Occhiali
- Rouen University Hospital, Department of Anaesthesiology, Critical Care and Perioperative Medicine, 1 rue de Germont, 76000 Rouen, France.
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Wang H, Gong X. Acute pituitary crisis after lumbar surgery: A case report. Medicine (Baltimore) 2023; 102:e36294. [PMID: 38050276 PMCID: PMC10695533 DOI: 10.1097/md.0000000000036294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
RATIONALE Patients with hypopituitarism often have no specific symptoms; that frequently results in missed diagnosis. An acute hypopituitarism crisis can be induced under stressful conditions. Here, we report a rare case of an acute pituitary crisis after lumbar surgery. PATIENT CONCERNS We describe a 62-year-old female who presented with refractory electrolyte disorders after lumbar surgery. In addition, she developed anorexia, nausea, vomiting, chest cavity effusion, ascites, pericardial effusion, anemia, low blood pressure, bradycardia, and unconsciousness after surgery. MRI showed an empty sella turcica. DIAGNOSES She was diagnosed with postoperative acute hypopituitary crisis. INTERVENTIONS The patient received hormone replacement therapy. OUTCOMES Her symptoms improved significantly following the initiation of hormone replacement therapy and was well 6 months after surgery. LESSONS Refractory postoperative complications, including electrolyte disorders, infection, nausea, vomiting, circulatory collapse, anemia, and coma, indicate an acute postoperative hypopituitary crisis.
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Affiliation(s)
- Hui Wang
- Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Xingrui Gong
- Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
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Alam A, Ashraf H, Malik AM, Fatima R. Sheehan's syndrome presenting as massive pericardial effusion, ventricular tachycardia and diabetes insipidus. BMJ Case Rep 2023; 16:e257504. [PMID: 37996133 PMCID: PMC10668181 DOI: 10.1136/bcr-2023-257504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Sheehan's syndrome (SS) is characterised by pituitary necrosis resulting from postpartum haemorrhage. While SS is uncommon in developed nations, it remains a prevalent cause of hypopituitarism in women, particularly in low/middle-income countries. Clinically, SS is characterised by a deficiency in anterior pituitary hormones; involvement of the posterior pituitary is less common. SS presenting as cardiac tamponade is rare, with only a few reported cases in the literature. In this report, we present the case of a patient with SS who arrived at the emergency department with symptoms of light-headedness, palpitations and dyspnoea. Echocardiography revealed a massive pericardial effusion with cardiac tamponade, and during treatment, the patient experienced ventricular tachycardia and circulatory collapse. The collaboration between various medical specialties, including emergency medicine, cardiology, critical care, endocrinology and radiology, played a crucial role in successful patient management. The multidisciplinary approach allowed for comprehensive care addressing acute cardiac complications and underlying hormonal deficiencies.
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Affiliation(s)
- Ahmad Alam
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Hamid Ashraf
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | | | - Razeen Fatima
- Department of Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Karaca Z, Unluhizarci K, Kelestimur F. Hypoprolactinemia. Does it matter? Redefining the hypopituitarism and return from a mumpsimus : "Absence of proof is not the proof of absence". Rev Endocr Metab Disord 2023:10.1007/s11154-023-09847-9. [PMID: 37875774 DOI: 10.1007/s11154-023-09847-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 10/26/2023]
Abstract
Prolactin (PRL) is secreted by the lactotroph cells in the anterior pituitary gland which is under inhibitory control of dopamine. The mature human PRL has more than 300 physiological actions including lactation, reproduction, homeostasis, neuroprotection, behavior, water and electrolyte balance, immunoregulation and embryonic and fetal development. PRL is involved in the growth and development of mammary gland, preparation of the breast for lactation in the postpartum period, synthesis of milk, and maintenance of milk secretion. Abnormalities in the synthesis and secretion of PRL may result in hyperprolactinemia or hypoprolactinemia. Although hyperprolactinemia has been extensively investigated in the literature, because of the subtle or unclearly defined symptoms, hypoprolactinemia is a less-known and neglected disorder. Failure of lactation is a well-known clinical manifestation of hypoprolactinemia. Recent studies reveal that hypoprolactinemia may have some effects beyond lactation such as increased risk for metabolic abnormalities including insulin resistance, abnormal lipid profile, obesity and sexual dysfunction. Very low level of PRL is suggested to be avoided in patients receiving dopamin agonist treatment to prevent unwanted effects of hypoprolactinemia. Another important point is that hypoprolactinemia is not included in the classification of hypopituitarism. Anterior pituitary failure is traditionally classified as isolated, partial and complete (panhypopituitarism) hypopituitarism regardless of prolactin level. Therefore, there are two kinds of panhypopituitarism: panhypopituitarism with normal or high PRL level and panhypopituitarism with low PRL level. In this review, we present two personal cases, discuss the diagnosis of hypoprolactinemia, hypoprolactinemia associated clinical picture and suggest to redefine the classification of hypopituitarism.
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Affiliation(s)
- Zuleyha Karaca
- Faculty of Medicine, Department of Endocrinology Kayseri, Erciyes University, Talas/Kayseri, Turkey
| | - Kursad Unluhizarci
- Faculty of Medicine, Department of Endocrinology Kayseri, Erciyes University, Talas/Kayseri, Turkey
| | - Fahrettin Kelestimur
- Faculty of Medicine, Department of Endocrinology İstanbul, Yeditepe University, Ataşehir/İstanbul, Turkey.
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Adil ML, Alvi M, Khan A, Qaiser SMM, Osman M, Bashir MN. From acute abdomen to hormonal crisis: Case report on a long-delayed Sheehan's syndrome diagnosis. Int J Surg Case Rep 2023; 111:108831. [PMID: 37738831 PMCID: PMC10523179 DOI: 10.1016/j.ijscr.2023.108831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Sheehan's syndrome (SS) is a rare cause of hypopituitarism resulting from postpartum haemorrhage and pituitary necrosis. It remains an underdiagnosed condition, especially in developing countries due to poor obstetric care and home deliveries. This case report highlights the significance of recognizing atypical presentations of SS, such as pancytopenia, to aid in early diagnosis and management. CASE PRESENTATION A 40-year-old female presented with acute abdomen symptoms and was initially diagnosed with acalculous cholecystitis. However, a detailed history revealed a history of postpartum haemorrhage 18 years prior, leading to a provisional diagnosis of SS. Further investigations confirmed panhypopituitarism, including hypothyroidism, hypocortisolism, and hypogonadism. Notably, the patient also exhibited pancytopenia, a rarely reported haematological manifestation of SS. DISCUSSION SS often presents with nonspecific symptoms, leading to delayed or missed diagnoses. In this case, the patient's initial presentation of acute abdomen symptoms was attributed to secondary adrenal insufficiency due to panhypopituitarism. The presence of pancytopenia, along with hyponatremia, further complicated the clinical picture. Hormone replacement therapy led to a remarkable improvement in the patient's condition, emphasizing the importance of early diagnosis and intervention. CONCLUSION SS is a common cause of panhypopituitarism in developing countries, but its atypical presentations, such as pancytopenia, are rare and often overlooked. This case highlights the need for increased awareness among clinicians to consider SS in patients with unexplained haematological abnormalities, particularly in regions with high rates of postpartum haemorrhage. Early recognition and appropriate hormone replacement therapy can significantly improve patients' outcomes and prevent long-term complications associated with this underdiagnosed syndrome.
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Affiliation(s)
| | - Mahrukh Alvi
- Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Aqsa Khan
- Rawal Institute of Health Sciences, Rawalpindi, Pakistan
| | | | - Muhammad Osman
- Rawal Institute of Health Sciences, Rawalpindi, Pakistan
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Laway BA, Sharma A, Choh NA, Shaheen F, Wani AI. Sella Turcica Size in Women with Sheehan Syndrome-A Case-Control Study. Indian J Endocrinol Metab 2023; 27:431-435. [PMID: 38107734 PMCID: PMC10723611 DOI: 10.4103/ijem.ijem_316_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/10/2022] [Accepted: 02/03/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Sheehan syndrome is a common cause of hypopituitarism in developing countries. Among risk factors, in addition to post-partum haemorrhage, a smaller sellar volume is also believed to predispose to pituitary necrosis. Some earlier studies have reported smaller sellar volume in these patients but involved a small number of patients and lacked matched controls. The main of the present study was to study the sellar volume in a large cohort of patients with Sheehan syndrome and compare it with age- and parity-matched controls. Methods Fifty women with Sheehan syndrome and an equal number of age- and parity-matched controls were studied. Baseline investigations, relevant hormonal assay, and MRI of pituitary were studied in all. Results Sellar volume was significantly lower in patients with Sheehan syndrome (334.50 ± 129.08 mm3 in patients as against 456.64 ± 169.25 mm3 in controls, P = 0.000). Far more women with Sheehan syndrome than controls had decreased sellar volume (40% vs. 12%). Conclusions Patients with Sheehan syndrome have a smaller sellar volume that may be a non-modifiable risk factor for the development of post-partum pituitary necrosis.
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Affiliation(s)
- Bashir Ahmad Laway
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Atul Sharma
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Naseer Ahmad Choh
- Department of Radio Diagnosis and Imaging, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Feroze Shaheen
- Department of Radio Diagnosis and Imaging, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Arshad Iqbal Wani
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
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Laway BA, Rasool A, Baba MS, Misgar RA, Bashir MI, Wani AI, Choh N, Shah O, Lone A, Shah Z. High prevalence of coronary artery calcification and increased risk for coronary artery disease in patients with Sheehan syndrome-A case-control study. Clin Endocrinol (Oxf) 2023; 98:375-382. [PMID: 36567411 DOI: 10.1111/cen.14871] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/22/2022] [Accepted: 12/22/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Patients with Sheehan syndrome (SS) are predisposed to coronary artery disease (CAD) due to risk factors like abdominal obesity, dyslipidemia and chronic inflammation. In addition to estimate CAD risk enhancers like high sensitive C reactive protein (hsCRP), apolipoprotein B (ApoB) and lipoprotein A [Lp(a)], this study applies Framingham risk score (FRS) and coronary artery calcium (CAC) score to compute a 10-year probability of cardiovascular (CV) events in SS patients. DESIGN Case-control study Sixty-three SS patients, on a stable hormonal replacement treatment except for growth hormone and 65 age, body mass index and parity-matched controls. MEASUREMENTS Measurement of serum hsCRP, ApoB and Lp(a) and estimation of CAC with 16-row multislice computed tomography scanner. RESULTS The concentrations of hsCRP, ApoB and Lp(a) were significantly higher in SS patients than in controls (p < .01). After calculating FRS, 95.2% of SS patients were classified as low risk, 4.8% as intermediate risk and all controls were classified as low risk for probable CV events. CAC was detected in 50.7% SS patients and 7.6% controls (p = .006). According to the CAC score, 26.9% SS patients were classified as at risk (CAC > 10) for incident CV events as against 1.6% controls. The mean Multi-Ethnic Study of Atherosclerosis (MESA) score was significantly higher in patients with SS than controls. CAC corelated significantly with fasting blood glucose (r = .316), ApoB (r = .549), LP(a) (r = .310) and FRS (r = .294). CONCLUSION Significant number of asymptomatic SS patients have high coronary artery calcium score and are classified at risk for CAD.
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Affiliation(s)
- Bashir Ahmad Laway
- Department of Endocrinology, Sher-I- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Abid Rasool
- Department of Endocrinology, Sher-I- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Mohammad Salem Baba
- Department of Endocrinology, Sher-I- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Raiz Ahmad Misgar
- Department of Endocrinology, Sher-I- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Mir Iftikhar Bashir
- Department of Endocrinology, Sher-I- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Arshad Iqbal Wani
- Department of Endocrinology, Sher-I- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Naseer Choh
- Department of Radiology, Sher-I- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Omair Shah
- Department of Radiology, Sher-I- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Ajaz Lone
- Department of Cardiology, Sher-I- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Zaffar Shah
- Department of Immunology & Molecular Medicine, Sher-I- Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
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Urhan E, Hacioglu A, Okcesiz I, Karaca Z, Kara CS, Unluhizarci K. The coexistence of newly diagnosed acromegaly with primary empty sella: More frequent than expected? Growth Horm IGF Res 2023; 68:101521. [PMID: 36427362 DOI: 10.1016/j.ghir.2022.101521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We investigated the coexistence of newly diagnosed acromegaly with primary empty sella (ES), which is considered to be a rare association, and the impact of ES on the laboratory, radiological and prognostic status of acromegaly. DESIGN Acromegaly patients diagnosed and followed-up between 2012 and 2021 were included. Empty sella was defined as the pituitary gland and adenoma filling <50% of the sella turcica on preoperative T1 magnetic resonance imaging (MRI). RESULTS 102 acromegalic patients (45 male, 57 female, 45.5 ± 12.8 (range: 20-70 years) were included and data of a median 3 years (range: 0.5-9 years) were presented. ES was detected in 19 (18.6%) patients and 4 had complete and 15 had partial ES. Although not significant, adenoma size and residual adenoma on MRI on postoperative 3rd month, and disease remission at last control were lower in acromegaly with ES than in acromegaly without ES, while the rate of female gender and remission on postoperative 3rd month were higher. While preoperative serum prolactin and nadir GH responses to OGTT were significantly lower in patients with ES, there was no difference in terms of other pituitary hormones among both groups. CONCLUSION The present study revealed the coexistence of newly diagnosed acromegaly with primary ES at a rate of nearly 20% which is more frequent than expected and this association is not rare. The presence of ES was not associated with any preoperative/postoperative pituitary hormone levels and remission status, except lower preoperative prolactin and nadir GH responses to OGTT.
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Affiliation(s)
- Emre Urhan
- Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey
| | - Aysa Hacioglu
- Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey
| | - Izzet Okcesiz
- Department of Radiology, Erciyes University Medical School, Kayseri, Turkey
| | - Zuleyha Karaca
- Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey
| | - Canan Sehit Kara
- Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey
| | - Kursad Unluhizarci
- Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey.
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Laway BA, Baba MS. Sheehan syndrome: Cardiovascular and metabolic comorbidities. Front Endocrinol (Lausanne) 2023; 14:1086731. [PMID: 36742387 PMCID: PMC9895769 DOI: 10.3389/fendo.2023.1086731] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
Sheehan syndrome (SS) caused by postpartum hemorrhage leads to partial or complete pituitary hormone deficiency. In addition to lipid and glucose abnormalities, patients with SS have increased body fat, insulin resistance (IR), coagulation abnormalities, increased leptin concentration, low-grade inflammation, and endothelial dysfunction that predispose them to cardiovascular diseases. Untreated growth hormone (GH) deficiency, hypogonadism, and excess glucocorticoid use are considered risk factors for these abnormalities. Compared to other hypopituitary subjects, patients with SS are younger and have a longer duration of disease and severe GH deficiency. Replacement with GH in addition to standard hormone replacement improves their cardiometabolic profile.
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16
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Das L, Dutta P. Approach to a case with an unusual cause of hypopituitarism. J Clin Endocrinol Metab 2022; 108:1488-1504. [PMID: 36573291 DOI: 10.1210/clinem/dgac747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Indexed: 12/29/2022]
Abstract
Hypopituitarism refers to insufficiency of one or more hormones of the pituitary and can be due to myriad causes. The clinical and radiological spectrum of the condition is heterogeneous, based on the age, gender, clinical setting and/or other past medical history. Hypopituitarism includes central hypocortisolism, hypothyroidism, hypogonadism and growth hormone deficiency. Both hypo- and hyperprolactinemia can be associated with hypopituitarism, with low prolactin signifying more extensive pituitary damage. Posterior pituitary insufficiency (arginine vasopressin deficiency), occurs either in isolation or with anterior pituitary hormone deficiency. Clinical symptomatology of hypopituitarism is usually non-specific and insidious in onset and progression. Overall, the most common cause of hypopituitarism is a pituitary adenoma and/or its management (surgery, radiotherapy, pharmacotherapy or a combination of these). However, it is this subset of patients which is more likely to be identified and managed timely, possibly alleviating the premature mortality associated with hypopituitarism. What is more challenging is the recognition of hypopituitarism in less common settings, which may be either due to direct involvement of the pituitary (infection, traumatic brain injury, or infiltrative causes) or indirectly as a consequence of the primary process (thalassemia, vasculotoxic snakebite, subarachnoid hemorrhage). These entities are often under-recognised, and increased awareness can help in greater recognition of the problem burden. Further, pituitary insufficiency in most of these settings is dynamic, which may progress, or rarely, show recovery of function. This renders complexity to the problem, but makes it even more imperative to suspect, screen and appropriately manage patients with less common causes of hypopituitarism.
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Affiliation(s)
- Liza Das
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh
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17
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Sheehan syndrome presenting as acute renal failure: A rare case report from Somalia. Ann Med Surg (Lond) 2022; 82:104641. [PMID: 36268361 PMCID: PMC9577661 DOI: 10.1016/j.amsu.2022.104641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/09/2022] [Indexed: 11/22/2022] Open
Abstract
Sheehan syndrome (SS) is one of the most common causes of pituitary gland dysfunction in childbearing women and occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. Rhabdomyolysis is a pathological condition of the skeletal muscles that can be present in the setting of adrenal insufficiency. It can cause serious end-organ complications such as acute renal failure. The combination of adrenal insufficiency due to Sheehan syndrome, rhabdomyolysis, and acute renal failure is extremely rare in the literature. In this case report, we present a 35-year-old female patient who presented with acute renal failure and was later diagnosed with Sheehan syndrome. She was put on Intravenous fluids, methylprednisolone, and levothyroxine treatment. The patient was hospitalized for 10 days and was discharged in good health. Sheehan syndrome may present with serious end-organ failure such as acute renal failure. Every woman with a history of lactation failure should be investigated for Sheehan syndrome. Adrenal insufficiency can be a cause of rhabdomyolysis due to electrolyte imbalance.
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18
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Gao H, Xiang Q, Li J, Yu M, Lan Y, Ba J, Liu Y, Tian H. Clinical analysis of the serum muscle enzyme spectrum of patients with newly diagnosed Sheehan's syndrome. Medicine (Baltimore) 2022; 101:e30834. [PMID: 36181079 PMCID: PMC9524868 DOI: 10.1097/md.0000000000030834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We investigated the factors associated with serum muscle enzyme elevation in patients with Sheehan's syndrome. A total of 48 patients who were newly diagnosed with Sheehan's syndrome were included and divided into 3 groups: Group 1, creatine kinase (CK) ≥ 1000 U/L; Group 2, 140 < CK < 1000 U/L; and Group 3, CK ≤ 140 U/L. Differences in serum muscle enzymes, serum electrolytes, blood glucose and hormones were compared among the 3 groups. A Spearman correlation analysis and multiple linear regression analysis were performed on serum muscle enzymes and the other variables. Four patients in Group 1 underwent electromyography. Fourteen, 26 and 8 patients were divided into Group 1, Group 2, and Group 3, respectively. The levels of plasma osmolality, serum sodium, free triiodothyronine (FT3) and free thyroxine (FT4) in Group 1 were lower than those in Group 3 at admission (P < .05). There were significant differences in CK, CK-MB, aspartate aminotransferase, lactate dehydrogenase, and alpha-hydroxybutyrate dehydrogenase among the three groups (P < .05). CK was correlated with serum sodium (r = -0.642, P < .001), serum potassium (r = -0.29, P = .046), plasma osmolality (r = -0.65, P < .001), FT3 (r = -0.363, P = .012), and FT4 (r = -0.450, P = .002). Moreover, creatine kinase isoenzyme-MB (CK-MB) was correlated with serum sodium (r = -0.464, P = .001) and plasma osmolality (r = -0.483, P < .001). The multiple linear regression showed that serum sodium was independently and negatively correlated with CK (r = -0.352, P = .021). The electromyogram results supported the existence of myogenic injury. Sheehan's syndrome is prone to be complicated by nontraumatic rhabdomyolysis, with both a chronic course and acute exacerbation. Serum muscle enzymes should be routinely measured. For patients with CK levels > 1000 U/L, a CK-MB/CK ratio < 6% can be a simple indicator to differentiate rhabdomyolysis from acute myocardial infarction. Abnormal serum muscle enzymes observed in Sheehan's syndrome may be associated with hypothyroidism and with hyponatremia in particular.
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Affiliation(s)
- Hongjiao Gao
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
- Department of Endocrinology, the Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Qiao Xiang
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
| | - Jindie Li
- Department of Endocrinology, the Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Meng Yu
- Department of Endocrinology, the Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Yalin Lan
- Department of Endocrinology, the Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Junqiang Ba
- Department of Endocrinology, the Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Yan Liu
- Department of Laboratory Medicine, the Third Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Haoming Tian
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Haoming Tian, West China Hospital of Sichuan University, Chengdu 610041, China (e-mail: )
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A Challenging Diagnosis of Sheehan’s Syndrome in Non-obstetric Critical Care and Emergency Settings: A Case Series of Five Patients with Varied Presentations. J Crit Care Med (Targu Mures) 2022; 8:214-222. [PMID: 36062035 PMCID: PMC9396951 DOI: 10.2478/jccm-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/14/2022] [Indexed: 11/20/2022] Open
Abstract
Sheehan’s syndrome is a life-threatening endocrine emergency seen in postpartum females secondary to ischemic pituitary necrosis. It is a frequent cause of hypopituitarism in developing countries that occurs secondary to postpartum haemorrhage (PPH). Patients with Sheehan’s syndrome often present with organ dysfunctions in critical care settings, secondary to stressors precipitating the underlying hormonal deficiencies. The initial clinical picture of Sheehan’s syndrome may mimic some other disease, leading to misdiagnosis and diagnostic delay. Strict vigilance, timely diagnosis, and appropriate management are essential to avoid diagnostic delay and to improve the patient outcome. In this case series, we describe 5 cases of previously undiagnosed Sheehan’s syndrome (including young, middle aged and postmenopausal females) that presented to critical care and emergency settings with organ failures.
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20
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Pituitary Apoplexy: Risk Factors and Underlying Molecular Mechanisms. Int J Mol Sci 2022; 23:ijms23158721. [PMID: 35955859 PMCID: PMC9369054 DOI: 10.3390/ijms23158721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/31/2022] [Accepted: 08/04/2022] [Indexed: 12/02/2022] Open
Abstract
Pituitary apoplexy is a rare syndrome, graded from asymptomatic subclinical apoplexy to a life-threatening condition due to pituitary ischemia or haemorrhage of an enlarged pituitary gland. The risk factors and the molecular underlying mechanisms are yet to be elucidated. We provide an overview of the general concepts, the potential factors associated with pituitary adenoma susceptibility for apoplectic events and the molecular mechanisms that could be involved such as HIF-1α/VEGF pathways and metalloproteinases activation, among others. The knowledge of the molecular mechanisms that could participate in the pathogenesis of pituitary apoplexy is crucial to advancement in the identification of future diagnostic tools and therapeutic targets in this rare but sometimes fatal condition.
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21
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Role of MRI and CT in the Evaluation of Headache in Pregnancy and the Postpartum Period. Neurol Clin 2022; 40:661-677. [PMID: 35871790 DOI: 10.1016/j.ncl.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Approximately 35% of acute headaches in pregnant women are secondary to an underlying condition. Headaches are also common in the postpartum period where they occur in 30% to 40% of patients. The majority of secondary headaches are due to hypertensive disorders: preeclampsia-eclampsia, posterior reversible encephalopathy syndrome, and acute arterial hypertension. Other causes include reversible cerebral vasoconstriction syndrome and pituitary apoplexy, as well as life-threatening conditions such as cerebral venous thrombosis. In this article, we review general recommendations for imaging the pregnant patients and discuss the imaging findings of common causes of headaches in pregnancy and the postpartum period.
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22
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Mandal S, Mukhopadhyay P, Ghosh S. DHEA on Sexual Function in Sheehan Syndrome: A Randomized Double-Blind Placebo-Controlled Crossover Trial. J Clin Endocrinol Metab 2022; 107:e3395-e3402. [PMID: 35481572 DOI: 10.1210/clinem/dgac260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The majority of women with Sheehan syndrome (SS) suffer from sexual dysfunction. Severe androgen deficiency is a major contributory factor. Dehydroepiandrosterone (DHEA) supplementation has been reported to have variable efficacious in improving female sexual dysfunction (FSD) in several trials but studies using DHEA in SS are not available. OBJECTIVE We aimed to study the use of DHEA supplementation in patients with SS. METHODS In this crossover trial, 28 participants with SS (age 39.7 ± 8.6 years) were divided into 2 groups (using block randomization) who received DHEA supplements (25 mg twice daily) or matched placebo sequentially for 3 months each. Female Sexual Functioning Index (FSFI) score and serum DHEA sulfate (DHEAS) were measured at baseline and after completion of each phase. Glycemic parameters, lipid profile, and liver enzymes were also measured to assess metabolic side effects. RESULTS There was significant improvement in FSFI score from baseline to end of the study in the DHEA group compared with the placebo group (P = 0.006). Mean FSFI score and most of the individual domains of female sexual dysfunction (FSD) improved with DHEA significantly in both groups (P = 0.001 for each group with DHEA). In those who received DHEA first followed by placebo, FSFI declined significantly after placebo (P = 0.041) but remained at an acceptable level of sexual functioning. Serum DHEAS increased significantly with DHEA treatment. No significant changes in glycemic index, lipid profile, and liver enzymes were noted with DHEA treatment. CONCLUSION A short duration of DHEA supplementation in women with SS with FSD is efficacious and safe.
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Affiliation(s)
- Soumita Mandal
- Department of Endocrinology, R. G. Kar Medical College, Kolkata, India
| | - Pradip Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Sujoy Ghosh
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research, Kolkata, India
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23
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Pituitary Apoplexy and Subdural Hematoma after Caesarean Section. Case Rep Obstet Gynecol 2022; 2022:3097949. [PMID: 35783221 PMCID: PMC9246620 DOI: 10.1155/2022/3097949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
Pituitary apoplexy can occur postpartum, and subdural hematoma following epidural anesthesia is a rare complication. Cooccurrence of these two complications is extremely rare and has not been previously reported in the literature. In this article, we present a case of pituitary apoplexy along with intracranial subdural hematoma happening two days after spinal anesthesia for cesarean section. The patient presented with peripheral facial nerve paralysis accompanied by headache, eye pain, and blurred vision and was diagnosed by imaging modalities. The patient made a good recovery with conservative treatment without serious health events.
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24
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Mandal S, Mukhopadhyay P, Ghosh S. Quality of life in Sheehan Syndrome. Indian J Endocrinol Metab 2022; 26:282-283. [PMID: 36248051 PMCID: PMC9555383 DOI: 10.4103/ijem.ijem_100_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Soumita Mandal
- Department of Endocrinology, R. G. Kar Medical College, Kolkata, West Bengal, India
| | - Pradip Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Sujoy Ghosh
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
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Zain A, Sivakumar A, Akah O, Shiza ST, Mahadevaiah A, Khan A. A Rare Case of Sheehan Syndrome With Cardiac Tamponade. Cureus 2022; 14:e24329. [PMID: 35607582 PMCID: PMC9123339 DOI: 10.7759/cureus.24329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/05/2022] Open
Abstract
Sheehan syndrome, also called postpartum hypopituitarism, is primarily caused by ischemic necrosis of the pituitary resulting from a complicated pregnancy. As the clinical presentations occur years after the complication, it is difficult to diagnose this condition. In this report, we discuss the case of a 35-year-old female with altered mental status, generalized edema, and loss of appetite. The condition was complicated due to the comorbidities of multiple medical conditions such as massive pericardial effusion and untreated jaundice. Her anorexic condition perfectly masked the malnourished appearance of the patient. After multiple laboratory tests and diagnostic imaging, the empty sella turcica of the patient propounded Sheehan syndrome. Replacement of the deficient hormones improved her condition after two weeks. Patients with complicated pregnancy history should be advised for diagnostic imaging early in life to appropriately manage Sheehan syndrome. A delay in diagnosis can have significant health and financial loss. Hormone replacement therapy is the only viable option as there is no cure to treat necrosed pituitary.
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Singh H, Afroze M, Shafi N, Bhat JA, Kawa IA, Laway BA, Bhat SA, Bhat MH, Zargar AH, Hussain A, Mir SA. Prevalence of coronary calcium deposits in Sheehan's syndrome patients on long term replacement treatment. Pituitary 2022; 25:92-99. [PMID: 34328604 DOI: 10.1007/s11102-021-01174-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Sheehan's Syndrome (SS) is one of the most important causes of hypopituitarism in developing countries with patients having varying degrees and severity of anterior pituitary hormone deficiency including growth hormone deficiency (GHD). SS is characterized by increased clustering of metabolic and proinflammatory risk factors predisposing them to increased cardiovascular morbidity and mortality. Coronary calcium deposits (CCD), a marker for significant coronary atherosclerosis, is used for evaluation in asymptomatic individuals of global cardiac risk to develop events related to coronary heart disease (CHD). This study therefore aimed to evaluate the prevalence of coronary artery disease in patients with SS appropriately replaced for pituitary hormone deficiencies but untreated for GHD. METHODS Thirty patients previously diagnosed with SS and stable on a conventional replacement treatment for at least 6 months before the study and thirty age and Body Mass Index (BMI) matched controls were enrolled in this observational study. The subjects underwent detailed clinical, biochemical, and hormone analysis. Coronary multidetector computed tomography was performed in 19 SS patients and 19 healthy participants by a 16-row multislice scanner. Non contrast acquisitions were performed to detect coronary calcifications. Calcium was quantified by the Agatston score (AS) in all subjects. AS > 10 indicates increased CHD risk. RESULTS The mean (± SD) age was 38.30 ± 10.73 years and the diagnostic delay was 11.35 ± 4.74 years. Patients with SS had significantly higher mean triglyceride, total cholesterol, and low density lipoprotein (LDL) cholesterol and lower HDL cholesterol concentrations on conventional replacement therapy. The prevalence of CCD was significantly higher in patients of SS compared to controls (42.1% vs. 5.3%; P = 0.023). The presence of CCD and AS > 10 were detected in 42.1% and 31.6% of patients respectively. The presence of significant calcification (Agatston score > 10) was documented in 75% of patients (6/8) of the SS patients with CCD compared to none in the control group (P = 0.019). (Left anteriordescending, 1; left circumflex, 2; right coronary artery, 2 and posterior descending, 1) CONCLUSION: Since coronary artery calcium is an independent predictor of CHD events, the presence of significant prevalence of CCD in patients with SS compared to healthy matched controls, undermines the importance of early risk stratification of SS individuals with plethora of conventional cardiovascular risk factors that are at relatively high risk to avoid the adverse vascular consequences.
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Affiliation(s)
- Hardeep Singh
- Department of Internal Medicine and Endocrinology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Mehak Afroze
- Department of Internal Medicine and Endocrinology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Nadia Shafi
- Department of Internal Medicine and Endocrinology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Javaid Ahmad Bhat
- Department of Internal Medicine and Endocrinology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Iram Ashaq Kawa
- Department of Biochemistry/Clinical Biochemistry, University of Kashmir, Srinagar, Jammu and Kashmir, India
| | - Bashir Ahmad Laway
- Department of Endocrinology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Shabir Ahmad Bhat
- Department of Radiology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Mohammad Hayat Bhat
- Department of Internal Medicine and Endocrinology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Abdul Hamid Zargar
- Endocrine and Diabetes Centre, Gulshan Nagar, Nowgam, Srinagar, Jammu and Kashmir, India
| | - Altaf Hussain
- Department of Internal Medicine and Endocrinology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Shahnaz Ahmad Mir
- Department of Internal Medicine and Endocrinology, Government Medical College, Srinagar, Jammu and Kashmir, India.
- Department of Endocrinology, Super-Specialty Hospital, Government Medical College, Srinagar, Jammu and Kashmir, India.
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Laway BA, Mir SUI, Bashir MI. Transient Hepatitis Secondary to Zoledronic Acid in a Woman with Sheehan Syndrome. Indian J Endocrinol Metab 2022; 26:93-94. [PMID: 35662756 PMCID: PMC9162249 DOI: 10.4103/ijem.ijem_484_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/27/2021] [Accepted: 01/09/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Bashir A. Laway
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India
| | - Sajad Ul Islam Mir
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India
| | - Mir Iftikhar Bashir
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India
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Al-Sharafi BA, Askar F, Qais AA. Management of a patient with Sheehan's syndrome and diabetes insipidus complicated by recurrent hyponatremia. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM210078. [PMID: 34515663 PMCID: PMC8495719 DOI: 10.1530/edm-21-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/17/2021] [Indexed: 11/11/2022] Open
Abstract
SUMMARY A 38-year-old female was initially seen in the intensive care unit after severe postpartum hemorrhage. She was initially diagnosed to have Sheehan's syndrome and after discharge, she was diagnosed to have a vesicovaginal fistula which initially caused a delay in diagnosing diabetes insipidus in the patient because she was having urinary incontinence. The patient had the vesicovaginal fistula repaired and was on replacement with levothyroxine, prednisone, and desmopressin. Years after her diagnosis, the patient experienced recurrent episodes of hyponatremia in the setting of desmopressin therapy. This case highlights the challenges of diagnosing diabetes insipidus in a patient with Sheehan's syndrome and a vesicovaginal fistula, as well as the long-term management of central diabetes insipidus in a resource-limited setting. LEARNING POINTS Sheehan's syndrome is rarely associated with diabetes insipidus, and in our patient, it was initially missed due to a vesicovaginal fistula which caused urinary incontinence. Water intoxication is more common in young children and older adults but can occur years after initiating treatment with desmopressin in adults and should be kept in mind when treating patients with hyponatremia who have hypopituitarism associated with diabetes insipidus. Water intoxication is much more common in patients with diabetes insipidus being treated with intranasal desmopressin than in those using the oral preparations.
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Affiliation(s)
- Butheinah A Al-Sharafi
- Department of Internal Medicine, School of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Faiza Askar
- Department of Internal Medicine, School of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Ahmed A Qais
- Department of Internal Medicine, School of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
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29
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Demir AY, Oldenburg-Ligtenberg CP, Toma-Stan BL, van de Wiel A. Misleading normal TSH and persistently elevated creatine kinase: clues to the diagnosis of chronic Sheehan's syndrome. BMJ Case Rep 2021; 14:e243992. [PMID: 34433531 PMCID: PMC8388264 DOI: 10.1136/bcr-2021-243992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Ayşe Y Demir
- Clinical Chemistry and Haematology, Meander Medical Centre, Amersfoort, The Netherlands
| | | | | | - Albert van de Wiel
- Department of Internal Medicine, Meander Medical Centre, Amersfoort, The Netherlands
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Mandal S, Mukhopadhyay P, Ghosh S. Sexual dysfunctions in Sheehan's syndrome. Endocr Pract 2021; 27:1212-1215. [PMID: 34311117 DOI: 10.1016/j.eprac.2021.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Sheehan's syndrome (SS) is not an uncommon cause of hypopituitarism in developing countries. Lack of sex-steroids both from ovaries and adrenals could lead to sexual dysfunction in SS. Sexual function is a neglected aspect of health in women in developing countries, though it contributes greatly towards quality of life and feeling of well being. Objective documentation of sexual function in SS is limited. MATERIALS AND METHODS Thirty two subjects with SS on conventional therapy (except Growth Hormone) were evaluated. SS was diagnosed as per standard criteria. Sexual function was assessed by validated questionnaires using Female Sexual Function Index (FSFI). Thirty healthy women of similar age range and socio-economic background were included as comparators. RESULTS Mean age (±SD) of study population and healthy controls were 39.9 (±8.6) and 38.2 (±6.8) years respectively. Median (IQR) interval between inciting event and diagnosis of SS was 8.3 (5.2-13.5) years. Thirty subjects were active sexually. Twenty eight (93%) had sexual dysfunction i.e. FSFI score ≤ 26.55. Median total FSFI scores in SS and controls were 20.8 and 29.05 respectively (p=0.001). There was statistically significant difference for individual parameter of sexual function i.e. desire, arousal, lubrication, orgasm and satisfaction between SS and controls. However pain during intercourse was not different. FSFI score in SS was not correlated with any of the endocrine parameters or duration of the disease since diagnosis. CONCLUSION Sexual dysfunction is very common affecting more than 90% of subjects with SS.
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Affiliation(s)
- Soumita Mandal
- Senior Resident, Department of Endocrinology, R. G. Kar medical College, Kolkata, India
| | - Pradip Mukhopadhyay
- Professor, Department of Endocrinology, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Sujoy Ghosh
- Professor, Department of Endocrinology, Institute of Post Graduate Medical Education & Research, Kolkata, India.
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Perinatal Management and Outcomes of Pregnancy Following Sheehan Syndrome: A Case Report and Literature Review. MATERNAL-FETAL MEDICINE 2021. [DOI: 10.1097/fm9.0000000000000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Genetu A, Anemen Y, Abay S, Bante SA, Mihrete KM. A 45-year-old female patient with Sheehan's syndrome presenting with imminent adrenal crisis: a case report. J Med Case Rep 2021; 15:229. [PMID: 33962642 PMCID: PMC8105925 DOI: 10.1186/s13256-021-02827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 03/25/2021] [Indexed: 11/25/2022] Open
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.
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Affiliation(s)
- Abere Genetu
- Department of Internal Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Yibeltal Anemen
- Department of Internal Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Sinshaw Abay
- Department of Internal Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Simachew Anemen Bante
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kebadnew Mulatu Mihrete
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Sadiq S, Chowdhury A. A Case of Sheehan Syndrome 7 Years Postpartum with Transaminitis and Hyperlipidemia. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930908. [PMID: 33951030 PMCID: PMC8112285 DOI: 10.12659/ajcr.930908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient: Female, 46-year-old Final Diagnosis: Sheehan syndrome Symptoms: Fatigue • light-headedness Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic
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Affiliation(s)
- Sanah Sadiq
- Internal Medicine, Mayo Clinic Health System - Southwest Minnesota region, Mankato, MN, USA
| | - Arnab Chowdhury
- Internal Medicine, Mayo Clinic Health System - Southwest Minnesota region, Mankato, MN, USA
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Garmes HM, Boguszewski CL, Miranda PAC, Martins MRA, da Silva SRC, Abucham JZ, de Castro Musolino NR, Vilar L, Portari LHC, Gadelha MR, Kasuki L, Naves LA, Czepielewski MA, de Almeida TS, Duarte FHG, Glezer A, Bronstein MD. Management of hypopituitarism: a perspective from the Brazilian Society of Endocrinology and Metabolism. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:212-230. [PMID: 33905631 PMCID: PMC10065316 DOI: 10.20945/2359-3997000000335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Hypopituitarism is a disorder characterized by insufficient secretion of one or more pituitary hormones. New etiologies of hypopituitarism have been recently described, including head trauma, cerebral hemorrhage, and drug-induced hypophysitis. The investigation of patients with these new disorders, in addition to advances in diagnosis and treatment of hypopituitarism, has increased the prevalence of this condition. Pituitary hormone deficiencies can induce significant clinical changes with consequent increased morbidity and mortality rates, while hormone replacement based on current guidelines protects these patients. In this review, we will first discuss the different etiologies of hypopituitarism and then address one by one the clinical aspects, diagnostic evaluation, and therapeutic options for deficiencies of TSH, ACTH, gonadotropin, and GH. Finally, we will detail the hormonal interactions that occur during replacement of pituitary hormones.
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Affiliation(s)
- Heraldo Mendes Garmes
- Unidade de Neuroendocrinologia, Divisão de Endocrinologia e Metabologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil,
| | - César Luiz Boguszewski
- Serviço de Endocrinologia e Metabologia, Departamento de Clínica Médica, Universidade Federal do Paraná (SEMPR), Curitiba, PR, Brasil,
| | | | | | - Silvia Regina Correa da Silva
- Unidade de Neuroendocrinologia, Divisão de Endocrinologia e Metabolismo, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Julio Zaki Abucham
- Unidade de Neuroendocrinologia, Divisão de Endocrinologia e Metabolismo, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Nina Rosa de Castro Musolino
- Unidade de Neuroendocrinologia, Divisão de Neurocirurgia Funcional, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, DP, Brasil
| | - Lucio Vilar
- Serviço de Endocrinologia, Hospital das Clínicas da Universidade Federal de Pernambuco, Recife, PE, Brasil
| | - Luiz Henrique Corrêa Portari
- Unidade de Neuroendocrinologia, Divisão de Endocrinologia e Metabolismo, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Mônica Roberto Gadelha
- Unidade de Neuroendocrinologia, Instituto Estadual do Cérebro Paulo Niemeyer, Centro de Pesquisa de Neuroendocrinologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Leandro Kasuki
- Unidade de Neuroendocrinologia, Instituto Estadual do Cérebro Paulo Niemeyer, Centro de Pesquisa de Neuroendocrinologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Luciana Ansaneli Naves
- Serviço de Endocrinologia, Faculdade de Medicina da Universidade de Brasília, Brasília, DF, Brasil
| | - Mauro Antônio Czepielewski
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Tobias Skrebsky de Almeida
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Andrea Glezer
- Unidade de Neuroendocrinologia, Laboratório de Endocrinologia Celular e Molecular LIM-25, Divisão de Endocrinologia e Metabolismo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marcello Delano Bronstein
- Unidade de Neuroendocrinologia, Laboratório de Endocrinologia Celular e Molecular LIM-25, Divisão de Endocrinologia e Metabolismo, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Prodam F, Caputo M, Mele C, Marzullo P, Aimaretti G. Insights into non-classic and emerging causes of hypopituitarism. Nat Rev Endocrinol 2021; 17:114-129. [PMID: 33247226 DOI: 10.1038/s41574-020-00437-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/11/2022]
Abstract
Hypopituitarism is defined as one or more partial or complete pituitary hormone deficiencies, which are related to the anterior and/or posterior gland and can have an onset in childhood or adulthood. The most common aetiology is a sellar or suprasellar lesion, often an adenoma, which causes hypopituitarism due to tumour mass effects, or the effects of surgery and/or radiation therapy. However, other clinical conditions, such as traumatic brain injury, and autoimmune and inflammatory diseases, can result in hypopituitarism, and there are also genetic causes of hypopituitarism. Furthermore, the use of immune checkpoint inhibitors to treat cancer is increasing the risk of hypopituitarism, with a pattern of hormone defects that is different from the classic patterns and depends on mechanisms that are specific for each drug. Moreover, autoantibody production against the pituitary and hypothalamus has been demonstrated in studies investigating the development or worsening of some cases of hypopituitarism. Finally, evidence suggests that posterior pituitary damage can affect oxytocin secretion. The aim of this Review is to summarize current knowledge on non-classic and emerging causes of hypopituitarism, so as to help clinicians improve early identification, avoid life-threatening events and improve the clinical care and quality of life of patients at risk of hypopituitarism.
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Affiliation(s)
- Flavia Prodam
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Marina Caputo
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Chiara Mele
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Paolo Marzullo
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Division of General Medicine, I.R.C.C.S. Istituto Auxologico Italiano, Ospedale San Giuseppe, Verbania, Italy
| | - Gianluca Aimaretti
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
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Sheehan Syndrome Presenting with Psychotic Manifestations Mimicking Schizophrenia in a Young Female: A Case Report and Review of the Literature. Case Rep Endocrinol 2020; 2020:8840938. [PMID: 33343948 PMCID: PMC7732407 DOI: 10.1155/2020/8840938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/20/2020] [Accepted: 11/26/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Sheehan syndrome presents with features of multiple hormone deficiencies including lactation failure and amenorrhoea as well as with features of central hypothyroidism and adrenocorticotropic hormone deficiency. Psychiatric manifestations are mostly limited to cognitive impairment. Psychotic presentations are rare and limited to case reports. Case Presentation. A 32-year-old female was evaluated for fearfulness and delusions for one year. She had persecutory and bizarre delusions, delusion of thought possession, and elementary auditory hallucinations. These began four months after the birth of her third child. The delivery had been complicated with postpartum haemorrhage. Her symptoms caused the functional decline and progressively worsened, resulting in suicidal ideation. Cognitive assessment revealed mild impairment in attention. Further inquiry revealed lethargy, constipation, cold intolerance, and lactation failure. She was slow, having dry skin, puffy face, and bradycardia with a blood pressure of 80/60 mmHg (supine) and 70/50 mmHg (standing). She had hyponatraemia, elevated creatine phosphokinase, low thyroxine, prolactin, FSH, LH, and IGF-1. She had poor cortisol and growth hormone response to the insulin tolerance test. MRI-pituitary showed empty sella. A diagnosis of Sheehan syndrome was made. Her symptoms improved completely after the initiation of levothyroxine and hydrocortisone. Conclusions Sheehan syndrome can present with psychotic symptoms mimicking schizophrenia with variable involvement of cognition. Detailed reporting of these patients would enhance better characterization of the clinical presentation and risk profile of these patients.
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Jose M, Amir S, Desai R. Chronic Sheehan's Syndrome - A Differential to be Considered in Clinical Practice in Women with a History of Postpartum Hemorrhage. Cureus 2019; 11:e6290. [PMID: 31938584 PMCID: PMC6942501 DOI: 10.7759/cureus.6290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
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. We describe the case of a 36-year-old female with eight years of non-specific symptoms of generalized myalgias and intense fatigue managed symptomatically all these years. Further clinical assessment revealed amenorrhea and agalactia ongoing for several years without a clinical diagnosis. A good history and physical led to the diagnosis during a routine outpatient visit. She had significant improvement noted following the commencement of treatment. Previous case reports describe cases being diagnosed after one or other complications from long-term panhypopituitarism. Through this case, we want to illustrate that undiagnosed Sheehan's syndrome is associated with long-term morbidity, and there should be a high index of suspicion for it to be diagnosed during a routine clinical visit and thus prevent complications before a diagnosis can be made. It is essential to create awareness, especially in developed countries like the United States, where it has received less attention over the last few years.
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Affiliation(s)
- Merin Jose
- Internal Medicine, Saint Peters University Hospital, New Brunswick, USA
| | - Saba Amir
- Internal Medicine, Saint Peters University Hospital, New Brunswick, USA
| | - Rajesh Desai
- Internal Medicine, Saint Peters University Hospital, New Brunswick, USA
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de Sá Cavalcante D, da Silva Castro MG, Quidute ARP, Martins MRA, Cid AMPL, de Barros Silva PG, Cadwell Williams J, Neves FS, Ribeiro TR, Costa FWG. Evaluation of bone texture imaging parameters on panoramic radiographs of patients with Sheehan's syndrome: a STROBE-compliant case-control study. Osteoporos Int 2019; 30:2257-2269. [PMID: 31372710 DOI: 10.1007/s00198-019-05086-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
Abstract
UNLABELLED Sheehan's syndrome (SHS) is a rare condition related to the risk of osteoporosis and evaluation of bone texture imaging features on panoramic radiographs would be suitable for this condition, which was the aim of the present study. Fractal dimension, lacunarity, and trabecular morphologic aspects were significantly altered in these patients. INTRODUCTION SHS is an important public health problem particularly in developing countries. It is characterized as postpartum hypopituitarism secondary to obstetric complications-related ischemic pituitary necrosis that shows significant systemic metabolic repercussions. Thus, this study aimed to evaluate bone texture parameters in digital panoramic radiographs of patients with SHS. METHODS A case-control study was conducted with 30 SHS patients from an Endocrinology and Diabetology Service of reference in Brazil, and 30 age- and sex-matched healthy controls. A custom computer program measured fractal dimension, lacunarity, and some morphologic features in the following mandibular regions of interest (50 × 50 pixels): below the mental foramen (F1), between the first and second molars (M1), and at the center of the mandibular ramus (R1). RESULTS The fractal analysis showed a statistically significant difference between the studied groups in all regions of interest. The fractal dimension in F1 (p = 0.016), M1 (p = 0.043), and R1 (p = 0.028) was significantly lower in SHS group, as well as lacunarity in R1 (p = 0.008). Additionally, several morphologic features were statistically significant in the SHS group (p < 0.05). CONCLUSION Therefore, individuals with SHS showed altered imaging texture parameters on panoramic radiographs, which reflect a smaller spatial organization of the bone trabeculae and, possibly, a state of reduced mineral bone density.
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Affiliation(s)
- D de Sá Cavalcante
- Department of Clinical Dentistry, Postgraduate Program in Dentistry, Federal University of Ceará, Alexandre Baraúna St 949, Rodolfo Teofilo, Fortaleza, Ceará, 60430-160, Brazil
| | - M G da Silva Castro
- Realistic Simulation Center, Univeristy Center UNICHRISTUS, R. João Adolfo Gurgel St 133, Cocó, Fortaleza, Ceará, 60190-060, Brazil
| | - A R P Quidute
- Division of Endocrinology and Diabetology, Walter Cantídio University Hospital, Alexandre Baraúna St 949, Rodolfo Teofilo, Fortaleza, Ceará, 60430-160, Brazil
| | - M R A Martins
- Division of Endocrinology and Diabetology, Walter Cantídio University Hospital, Alexandre Baraúna St 949, Rodolfo Teofilo, Fortaleza, Ceará, 60430-160, Brazil
| | - A M P L Cid
- Department of Clinical Dentistry, Postgraduate Program in Dentistry, Federal University of Ceará, Alexandre Baraúna St 949, Rodolfo Teofilo, Fortaleza, Ceará, 60430-160, Brazil
| | - P G de Barros Silva
- Department of Clinical Dentistry, Postgraduate Program in Dentistry, Federal University of Ceará, Alexandre Baraúna St 949, Rodolfo Teofilo, Fortaleza, Ceará, 60430-160, Brazil
| | - J Cadwell Williams
- Department of Anatomy and Cell Biology, Indiana School of Medicine, 635 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - F S Neves
- Division of Oral Radiology, School of Dentistry, Federal University of Bahia, Araújo Pinho ave 62, Canela, Salvador, Bahia, 40110-040, Brazil
| | - T R Ribeiro
- Department of Clinical Dentistry, Postgraduate Program in Dentistry, Federal University of Ceará, Alexandre Baraúna St 949, Rodolfo Teofilo, Fortaleza, Ceará, 60430-160, Brazil
| | - F W G Costa
- Department of Clinical Dentistry, Postgraduate Program in Dentistry, Federal University of Ceará, Alexandre Baraúna St 949, Rodolfo Teofilo, Fortaleza, Ceará, 60430-160, Brazil.
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Abstract
The principal role of prolactin in mammals is the regulation of lactation. Prolactin is a hormone that is mainly synthesized and secreted by lactotroph cells in the anterior pituitary gland. Prolactin signalling occurs via a unique transmembrane prolactin receptor (PRL-R). The structure of the PRL-R has now been elucidated and is similar to that of many biologically fundamental receptors of the class 1 haematopoietic cytokine receptor family such as the growth hormone receptor. The PRL-R is expressed in a wide array of tissues, and a growing number of biological processes continue to be attributed to prolactin. In this Review, we focus on the newly discovered roles of prolactin in human health and disease, particularly its involvement in metabolic homeostasis including body weight control, adipose tissue, skin and hair follicles, pancreas, bone, the adrenal response to stress, the control of lactotroph cell homeostasis and maternal behaviour. New data concerning the pathological states of hypoprolactinaemia and hyperprolactinaemia will also be presented and discussed.
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Affiliation(s)
- Valérie Bernard
- Inserm U1185, Faculté de Médecine Paris Sud, Université Paris-Saclay, Le Kremlin Bicêtre, France
- Hôpital Saint Antoine, Service d'Endocrinologie et des Maladies de la Reproduction, Paris, France
| | - Jacques Young
- Inserm U1185, Faculté de Médecine Paris Sud, Université Paris-Saclay, Le Kremlin Bicêtre, France
- Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Paris, France
| | - Nadine Binart
- Inserm U1185, Faculté de Médecine Paris Sud, Université Paris-Saclay, Le Kremlin Bicêtre, France.
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Petersenn S, Christ-Crain M, Droste M, Finke R, Flitsch J, Kreitschmann-Andermahr I, Luger A, Schopohl J, Stalla G. Pituitary Disease in Pregnancy: Special Aspects of Diagnosis and Treatment? Geburtshilfe Frauenheilkd 2019; 79:365-374. [PMID: 31000881 PMCID: PMC6461462 DOI: 10.1055/a-0794-7587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/14/2018] [Accepted: 11/10/2018] [Indexed: 02/06/2023] Open
Abstract
The diagnosis and treatment of pituitary disease in pregnancy represents a special clinical challenge. Not least because there is very little data on the treatment of pregnant patients with pituitary disorders. A selective search of the literature was carried out with the aim of compiling evidence about the diagnosis and treatment of pituitary disease in pregnancy. The search covered the databases PubMed/MEDLINE including PubMed Central and also used the Livivo (ZB MED) search engine. Recent studies were evaluated for recommendations about the care of pregnant patients with hormone-inactive and hormone-active pituitary adenomas (prolactinoma, acromegaly and Cushing's disease), pituitary insufficiency, pituitary apoplexy and hypophysitis. The most well-established forms of treatment are for prolactinoma, due to the incidence of this disease and its impact on fertility. When pregnancy has been confirmed, prolactinoma treatment with dopamine agonists should be paused. Although microprolactinomas rarely increase significantly in size after the administration of dopamine agonists is discontinued, symptomatic tumor growth of macroprolactinomas can occur. In such cases, treatment with dopamine agonists can be resumed. If the primary tumor is large and the risk that it will continue to grow is high, it may be necessary to continue medical treatment from the start of pregnancy. If one of the partners has a pituitary disorder, it is often still possible for many couples to achieve their wish of having children if they receive medical support to plan and the pregnancy is carefully monitored. Given the complexity of pituitary disease, pregnant patients with pituitary disorders should be cared for and treated by a multidisciplinary team in centers specializing in the diagnosis and treatment of pituitary disease.
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Affiliation(s)
- Stephan Petersenn
- ENDOC Praxis für Endokrinologie, Andrologie und medikamentöse Tumortherapie, Hamburg, Germany
| | - Mirjam Christ-Crain
- Endokrinologie, Diabetologie & Metabolismus. Universitätsspital Basel, Basel, Switzerland
| | - Michael Droste
- Endokrinologie, Diabetologie, Hormonanalytik. MEDICOVER MVZ, Oldenburg, Germany
| | - Reinhard Finke
- Praxis an der Kaisereiche (üBAG), Berlin-Friedenau, Germany
| | - Jörg Flitsch
- Klinik und Poliklinik für Neurochirurgie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Anton Luger
- Universitätsklinik für Innere Medizin III, Klinische Abteilung für Endokrinologie & Stoffwechsel, Medizinische Universität Wien, Wien, Austria
| | - Jochen Schopohl
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | - Günter Stalla
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany.,Medicover Neuroendokrinologie, München, Germany
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Agarwal P, Gomez R, Bhatia E, Yadav S. Decreased bone mineral density in women with Sheehan's syndrome and improvement following oestrogen replacement and nutritional supplementation. J Bone Miner Metab 2019; 37:171-178. [PMID: 29464357 DOI: 10.1007/s00774-018-0911-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/23/2018] [Indexed: 11/29/2022]
Abstract
Sheehan's syndrome (SS) is an important cause of pan-hypopituitarism in women. There is scanty information on bone mineral density (BMD) in this condition. We determined BMD and the changes in BMD after oestrogen (E2) replacement and nutritional supplementation in women with SS. In a cross-sectional study, BMD was measured by DEXA in 83 patients [age (mean ± SD) 42 ± 9.2 years] and compared with an equal number of matched controls. In a sub-set of 19 patients, we conducted an open-label, prospective study to determine changes in BMD after 1 year of replacement of E2, and calcium and vitamin D3 supplementation. All patients had low serum IGF-1 and E2, while 98% had ≥ 3 pituitary hormone deficiencies. Compared with Indian reference standards, 47% had decreased bone mass (Z-score ≤ - 2.0). BMD Z-scores were decreased at all sites, being most marked in the lumbar spine and femoral neck. At the lumbar spine, BMD was lowest among the age group 21-30 years. Women with SS also had significantly lower BMD Z-scores at all three sites on comparison with ethnic controls. On multivariate analysis, BMD Z-score was associated with weight, daily calcium intake and age (lumbar spine). In the prospective study, 1 year of therapy improved BMD Z-score at lumbar spine (- 1.4 ± 1.2 vs. - 1.1 ± 1.1, p = 0.02), but not at hip or femoral neck. In conclusion, patients with SS had significantly lower BMD compared to controls at all three sites. Replacement of E2 and supplementation with calcium/vitamin D3 lead to significant improvement in lumbar spine BMD.
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Affiliation(s)
- Purnima Agarwal
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Ramesh Gomez
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Eesh Bhatia
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Subhash Yadav
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
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Mansour AA, Alhamza AHA, Almomin AMSA, Zaboon IA, Alibrahim NTY, Hussein RN, Kadhim MB, Alidrisi HAY, Nwayyir HA, Mohammed AG, Al-Waeli DK, Hussein IH. Spectrum of Pituitary disorders: A retrospective study from Basrah, Iraq. F1000Res 2018; 7:430. [PMID: 30026929 PMCID: PMC6039954 DOI: 10.12688/f1000research.13632.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Pituitary disorders spectrum includes a wide variety of diseases.This study aimed at a comprehensive description of such disorders for patients from Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) in Basrah (Southern Iraq). Methods: Retrospective data analysis of FDEMC for the period from January 2012 through June 2017. We included all patients with pituitary disorders who have MRI pituitary. Results: The pituitary disorders were more common among women. Those with macroadenoma were older than those with microadenoma with nearly equal gender prevalence of macroadenoma. Pituitary adenoma constituted the bulk of pituitary disorders in this registry (67.2%). Growth hormone secreting adenoma were the commonest adenoma seen in 41.0% followed by clinically non-functioning pituitary adenoma(NFPA)in 31.4% and prolactinoma in 26.9%. About 64.8% of pituitary adenoma was macroadenoma. Macroadenoma was seen in 73.4 % of growth hormone secreting adenoma, 61.2% in NFPA and 62.0% of prolactinoma (of them six were giant prolactinoma) Conclusion: Pituitary adenoma constituted the bulk of pituitary disorders in Basrah, growth hormone secreting adenoma is the commonest adenoma followed by NFPA and prolactinoma due to referral bias. A change in practice of pituitary adenoma treatment is needed.
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Affiliation(s)
- Abbas Ali Mansour
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Ali Hussain Ali Alhamza
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Ammar Mohammed Saeed Abdullah Almomin
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Ibrahim Abbood Zaboon
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Nassar Taha Yaseen Alibrahim
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Rudha Naser Hussein
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Muayad Baheer Kadhim
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Haider Ayad Yassin Alidrisi
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Hussein Ali Nwayyir
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Adel Gassab Mohammed
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Dheyaa Kadhim Al-Waeli
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Ibrahim Hani Hussein
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
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Mansour AA, Alhamza AHA, Almomin AMSA, Zaboon IA, Alibrahim NTY, Hussein RN, Kadhim MB, Alidrisi HAY, Nwayyir HA, Mohammed AG, Al-Waeli DK, Hussein IH. Spectrum of Sellar and Parasellar Region Lesions: A retrospective study from Basrah, Iraq. F1000Res 2018; 7:430. [PMID: 30026929 PMCID: PMC6039954 DOI: 10.12688/f1000research.13632.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 09/27/2023] Open
Abstract
Background: Sellar and parasellar region lesions spectrum includes a wide variety of diseases. This study aimed at providing a comprehensive overview of such lesions in patients from Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) in Basrah (Southern Iraq). Methods: Retrospective data analysis from FDEMC for the period January 2012 through June 2017. We included all patients with sellar and parasellar region lesions who received a MRI scan on their pituitary region Results: The total enrolled patients were 232 (84 men and 148 women),with age range 15-75 years.Pituitary disease and adenoma were more common among women. Those with macroadenoma were older than those with microadenoma, with nearly equal gender prevalence of macroadenoma. Pituitary adenoma constituted the bulk of pituitary disease in this setting (67.2%). Growth hormone secreting adenoma were the most common adenoma seen in 41.0%, followed by clinically non-functioning pituitary adenoma (NFPA) in 31.4% and prolactinoma in 26.9%. About 64.8% of pituitary adenoma was macroadenoma. Macroadenoma was seen in 73.4% of growth hormone secreting adenoma (acromegaly), 61.2% in NFPA and 62.0% of prolactinom a(of them six were giant prolactinoma). Conclusion: Pituitary adenoma constituted the bulk of sellar and parasellar region lesions, growth hormone secreting adenoma is the the most common adenoma followed by NFPA and prolactinoma due to referral bias. A change in practice of adenoma treatment is needed.
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Affiliation(s)
- Abbas Ali Mansour
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Ali Hussain Ali Alhamza
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Ammar Mohammed Saeed Abdullah Almomin
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Ibrahim Abbood Zaboon
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Nassar Taha Yaseen Alibrahim
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Rudha Naser Hussein
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Muayad Baheer Kadhim
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Haider Ayad Yassin Alidrisi
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Hussein Ali Nwayyir
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Adel Gassab Mohammed
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Dheyaa Kadhim Al-Waeli
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
| | - Ibrahim Hani Hussein
- Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Diabetes, Endocrine and Metabolism Division, Department of Medicine, Basrah College of Medicine,Hattin post office. P.O Box: 142, Basrah, 61013, Iraq
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Mittal A, Ray A, Talupula RM, Sood R. Sheehan's syndrome presenting as cardiac tamponade. BMJ Case Rep 2018; 2018:bcr-2017-223129. [PMID: 29431100 DOI: 10.1136/bcr-2017-223129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 50-year-old woman presented with progressive dyspnoea and oedema with rapid deterioration over the last few days. Clinical examination revealed hypotension with cold clammy skin, raised jugular venous pressure and muffled heart sounds and was diagnosed to have cardiac tamponade, later confirmed on two-dimensional echocardiography. However, patient had bradycardia, and the other striking examination findings were coarse facies with pallor, madarosis, absent axillary and pubic hair and breast atrophy. Her blood sugar level was also low. Detailed history revealed an episode of postpartum haemorrhage with lactation failure and early menopause. Pericardiocentesis was done with a pig-tail catheter. Hormone profile and MRI brain confirmed the diagnosis of Sheehan's syndrome. Patient improved on treatment with thyroxine and hydrocortisone supplementation and was discharged with education about stress dosing.
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Affiliation(s)
- Ankit Mittal
- Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Animesh Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rita Sood
- Medicine, All India Institute of Medical Sciences, New Delhi, India
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Laway BA, Sumji S. Preservation of Thyrotroph Function in Sheehan's Syndrome. Indian J Endocrinol Metab 2017; 21:931-932. [PMID: 29285464 PMCID: PMC5729689 DOI: 10.4103/ijem.ijem_346_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bashir Ahmad Laway
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sajad Sumji
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Pekic S, Popovic V. DIAGNOSIS OF ENDOCRINE DISEASE: Expanding the cause of hypopituitarism. Eur J Endocrinol 2017; 176:R269-R282. [PMID: 28258131 DOI: 10.1530/eje-16-1065] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/17/2017] [Accepted: 03/02/2017] [Indexed: 12/14/2022]
Abstract
Hypopituitarism is defined as one or more pituitary hormone deficits due to a lesion in the hypothalamic-pituitary region. By far, the most common cause of hypopituitarism associated with a sellar mass is a pituitary adenoma. A high index of suspicion is required for diagnosing hypopituitarism in several other conditions such as other massess in the sellar and parasellar region, brain damage caused by radiation and by traumatic brain injury, vascular lesions, infiltrative/immunological/inflammatory diseases (lymphocytic hypophysitis, sarcoidosis and hemochromatosis), infectious diseases and genetic disorders. Hypopituitarism may be permanent and progressive with sequential pattern of hormone deficiencies (radiation-induced hypopituitarism) or transient after traumatic brain injury with possible recovery occurring years from the initial event. In recent years, there is increased reporting of less common and less reported causes of hypopituitarism with its delayed diagnosis. The aim of this review is to summarize the published data and to allow earlier identification of populations at risk of hypopituitarism as optimal hormonal replacement may significantly improve their quality of life and life expectancy.
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Affiliation(s)
- Sandra Pekic
- School of MedicineUniversity of Belgrade, Belgrade, Serbia
- Clinic of EndocrinologyDiabetes and Metabolic Diseases, University Clinical Center Belgrade, Belgrade, Serbia
| | - Vera Popovic
- School of MedicineUniversity of Belgrade, Belgrade, Serbia
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