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Gradinaru E, Furculescu C, Trandafir A, Opris-Belinski D, Saulescu IC. Myopathic syndrome revealing a rare condition: Sheehan syndrome, a case-based review. Clin Rheumatol 2023; 42:1705-1712. [PMID: 36757535 DOI: 10.1007/s10067-023-06535-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/16/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
This report presents a case of a Sheehan syndrome diagnosed with a delay of 29 years after occurrence of first symptoms, following a laborious birth ended with dead fetus and massive hemorrhage. The 50-year-old patient, with early menopause from the age of 21, is referred to our rheumatology department to investigate the etiology of a myopathic syndrome, which started 2 months before and gradually worsened. The differential diagnosis took into consideration the autoimmune, infectious, paraneoplastic, endocrinological, and drug-induced myopathic syndrome. Paraclinical investigations revealed panhypopituitarism, and cerebral magnetic resonance imaging detected empty-sella. The etiology of a myopathic syndrome is often multifactorial; therefore, it is important to continue the investigations even after identifying one possible etiological factor, especially when it does not seem to fully explain the clinical-paraclinical picture. Usually, the multiple dimensions of panhypopituitarism bring the patient to various medical specialties depending on the dominant symptomatology. Given the rarity of the above-mentioned syndrome in the present, and the long gap between the initial event and the final diagnosis, its identification continues to be a challenge.
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Affiliation(s)
- Elena Gradinaru
- Department of Internal Medicine and Rheumatology, Sfanta Maria" Hospital, 011172, Bucharest, Romania
| | - Catalin Furculescu
- Department of Internal Medicine and Rheumatology, Sfanta Maria" Hospital, 011172, Bucharest, Romania
| | - Andreea Trandafir
- Department of Internal Medicine and Rheumatology, Sfanta Maria" Hospital, 011172, Bucharest, Romania.,Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, 050474, Bucharest, Romania
| | - Daniela Opris-Belinski
- Department of Internal Medicine and Rheumatology, Sfanta Maria" Hospital, 011172, Bucharest, Romania.,Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, 050474, Bucharest, Romania
| | - Ioana Cristina Saulescu
- Department of Internal Medicine and Rheumatology, Sfanta Maria" Hospital, 011172, Bucharest, Romania. .,Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, 050474, Bucharest, Romania.
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The Symptoms Get Worse after Pregnancy in Sheehan's Syndrome: A Case Report. Case Rep Med 2012; 2012:271345. [PMID: 23049563 PMCID: PMC3461311 DOI: 10.1155/2012/271345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 08/22/2012] [Indexed: 11/17/2022] Open
Abstract
Sheehan's syndrome, which is pituitary necrosis after severe postpartum hemorrhage and hypovolemia, may cause hypopituitarism immediately or several years later, depending on the degree of tissue destruction. We report an unusual case, in which a 55-year-old woman with Sheehan's syndrome got worse symptoms after spontaneous labor. In 1998, she had severe postpartum hemorrhage and pituitary necrosis during the third delivery, thus it was diagnosed as Sheehan's syndrome by clinical manifestations, laboratory tests, and magnetic resonance imaging. She was treated by replacement therapy including hydrocortisone and levothyroxine sodium. However, she had the fourth spontaneous pregnancy in 2000 and got worse symptoms after delivery. We carefully concluded that pregnancy provided no evidence against the diagnosis of Sheehan's syndrome because pregnancy might improve hypopituitarism by stimulating the pituitary remnant to undergo hyperplasia and irritating the placenta to secrete hormone. However, pregnancy might aggravate the symptoms by inducing autoimmunity as well. All in all, early diagnosis and adequate medical treatment are important to provide a good prognosis of Sheehan's syndrome.
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