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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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2
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Makharia A, Lakhotia M, Tiwari V, Gopal K. Recurrent hypoglycaemia and dilated cardiomyopathy: delayed presentation of Sheehan's syndrome. BMJ Case Rep 2021; 14:e242747. [PMID: 34162619 PMCID: PMC8230959 DOI: 10.1136/bcr-2021-242747] [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: 05/26/2021] [Indexed: 11/03/2022] Open
Abstract
Sheehan's syndrome (SS) is ischaemic necrosis of the pituitary gland due to massive postpartum haemorrhage. The clinical manifestations may vary from subtle to life-threatening and may present immediately after delivery or many years later. We present a case history of a 58-year-old non-diabetic woman who had undetected SS and presented with two unusual manifestations, including recurrent hypoglycaemia and dilated cardiomyopathy 34 years after delivery. The dilated cardiomyopathy reversed partially after treatment.
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Affiliation(s)
- Archita Makharia
- General Medicine, Dr Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Manoj Lakhotia
- General Medicine, Dr Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Vineet Tiwari
- General Medicine, Dr Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Kishan Gopal
- General Medicine, Dr Sampurnanand Medical College, Jodhpur, Rajasthan, India
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3
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Verhoestraete P, Carpentier M, Donck J, Vandekerckhove H. Dilated cardiomyopathy and rhabdomyolysis caused by hypopituitarism: a challenging diagnosis. Acta Cardiol 2019; 75:593-597. [PMID: 31536463 DOI: 10.1080/00015385.2019.1665848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | - Jan Donck
- Department of Nephrology, AZ Sint-Lucas Ghent, Ghent, Belgium
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Affiliation(s)
- Lucia Baris
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Obstetric Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jérôme Cornette
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mark R Johnson
- Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - Karen Sliwa
- Department of Medicine, Hatter Institute, Cape Town, South Africa
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5
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Huang D, Kreitler K, Tilton S, Cavarocchi NC, Hirose H. Cardiogenic Shock Requiring Extracorporeal Membrane Oxygenation Support in a Patient with Panhypopituitarism: A Case Report. Cureus 2019; 11:e4995. [PMID: 31497426 PMCID: PMC6726413 DOI: 10.7759/cureus.4995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We present a 58-year-old female with a past history of a pituitary adenoma resected two years prior to admission who developed polymorphic ventricular tachycardia and cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We noted that the patient had stopped taking all of her medications six months prior to presentation. An extensive workup revealed acute panhypopituitarism with secondary hypothyroidism, secondary adrenal insufficiency, and central diabetes insipidus. She was immediately initiated on thyroid and adrenal hormone replacement therapy as well as fluid replacement. Within five days of her medical treatment, the patient's cardiac function improved and she was successfully weaned from VA-ECMO and subsequently discharged home with appropriate hormone replacement therapy.
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Affiliation(s)
- Denis Huang
- Surgery, Thomas Jefferson University, Philadelphia, USA
| | - Kristin Kreitler
- Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Scott Tilton
- Surgery, Critical Care, Penn Presbyterian Medical Center, Philadelphia, USA
| | | | - Hitoshi Hirose
- Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, USA
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6
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Shinde SD, Sabnis GR, Lanjewar CP, Kerkar PG. A rare endocrine cause of electrical storm - a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2017; 1:ytx008. [PMID: 31020067 PMCID: PMC6176984 DOI: 10.1093/ehjcr/ytx008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/18/2017] [Accepted: 10/04/2017] [Indexed: 11/30/2022]
Abstract
Sheehan’s syndrome, also called Simmond’s syndrome, postpartum apoplexy, postpartum pituitary necrosis, and postpartum panhypopituitary syndrome, is the name given to postpartum hypopituitarism. The syndrome is caused by an infarction in the adenohypophysis, usually precipitated by massive uterine haemorrhage and hypovolemic shock during or after childbirth. Extensive destruction of pituitary cells results in varying degree of hypopituitarism. Acute loss of adenohypophysis function can be fatal without glucocorticoid and thyroid replacement therapy and survivors will require life time hormonal replacement therapy. Most cases present in the postpartum period with lactation failure or after months to years after the delivery. In many affected women, anterior pituitary dysfunction is not diagnosed for many years. Dyselectrolytemia is one of a common presentation in Sheehan’s syndrome. Herein, we report a case of a 35-year old female with a history of obstetric hysterectomy 2 years ago in view of severe postpartum haemorrhage with history of failure of lactation and three episodes of syncope since last 1½ years and now presented with polymorphic ventricular tachycardia which required DC cardioversion. She was referred as a case of long QT syndrome. On investigating further, she had hypokalaemia secondary to hypopituitarism due to Sheehan’s syndrome.
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Affiliation(s)
- Sunny D Shinde
- Department of Cardiology, Seth G S Medical College and King Edward VII Memorial Medical College, Acharya Donde Marg, Parel, Mumbai 400012, India
| | - Girish R Sabnis
- Department of Cardiology, Seth G S Medical College and King Edward VII Memorial Medical College, Acharya Donde Marg, Parel, Mumbai 400012, India
| | - Charan P Lanjewar
- Department of Cardiology, Seth G S Medical College and King Edward VII Memorial Medical College, Acharya Donde Marg, Parel, Mumbai 400012, India
| | - Prafulla G Kerkar
- Department of Cardiology, Seth G S Medical College and King Edward VII Memorial Medical College, Acharya Donde Marg, Parel, Mumbai 400012, India
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Liang L, Liu JB, Chen FQ, Zhao J, Zhang XL. Refractory hypotension induced by Sheehan syndrome with pituitary crisis: A case report. Exp Ther Med 2017; 13:2097-2101. [PMID: 28565814 PMCID: PMC5443209 DOI: 10.3892/etm.2017.4188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 12/19/2016] [Indexed: 11/17/2022] Open
Abstract
The present study reported on an unusual case of refractory hypotension induced by Sheehan syndrome with pituitary crisis and explored the causes and treatment of hypotension in hypopiptuitarism. Refractory hypotension is a rare and severe complication of longstanding hypopituitarism induced by Sheehan syndrome with pituitary crisis. A 48-year-old Chinese woman with pituitary crisis due to Sheehan syndrome developed refractory hypotension and received longstanding vasopressor blood pressure support and hormone replacement therapy. Besides normalized blood pressure, echocardiography over 3 months revealed partial reversibility of her cardiac function with hormone replacement therapy. Consistent numerous studies reviewed, hormone replacement therapy may improve cardiac function in patients with cardiomyopathy linked to Sheehan syndrome. A retrospective study of 77 cases with hypopituitarism encountered at Qilu Hospital of Shandong University (Jinan, China) was also performed and the incidence rate of hypotension was analyzed, revealing that the present case was the first of refractory hypotension induced by Sheehan syndrome with pituitary crisis at this institution in 16 years.
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Affiliation(s)
- Lu Liang
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong 250000, P.R. China
| | - Jin-Bo Liu
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong 250000, P.R. China
| | - Fu-Qin Chen
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong 250000, P.R. China
| | - Jing Zhao
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250000, P.R. China
| | - Xiao-Li Zhang
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong 250000, P.R. China
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Giri S, Bansal P, Malik S, Bansal R. Hypopituitarism presenting as congestive heart failure. J Postgrad Med 2017; 63:268-270. [PMID: 28272076 PMCID: PMC5664874 DOI: 10.4103/0022-3859.201424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Sheehan's syndrome (SS) develops as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage and is characterized by various degrees of hypopituitarism. Although the occurrence of SS is now rare, it should still be considered in any woman with a history of peripartum hemorrhage who develops manifestations of pituitary hormone deficiency any time following the event. Appropriate hormone replacement therapy results in marked clinical improvement. We present an unusual case of SS in a young lady who continued to have normal menstruation after the index event, had two spontaneous pregnancies, and was diagnosed only 11 years later when she presented to us with acute heart failure.
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Affiliation(s)
- S Giri
- Department of Medicine, University College of Medical Sciences, GTB Hospital, New Delhi, India
| | - P Bansal
- Department of Medicine, University College of Medical Sciences, GTB Hospital, New Delhi, India
| | - S Malik
- Department of Medicine, University College of Medical Sciences, GTB Hospital, New Delhi, India
| | - R Bansal
- Department of Medicine, University College of Medical Sciences, GTB Hospital, New Delhi, India
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Ikegami Y, Fukuda T, Jo R, Momiyama Y. Reversible Cardiomyopathy Accompanied by Secondary Adrenal Insufficiency. Circ Heart Fail 2016; 9:e002919. [PMID: 26920218 DOI: 10.1161/circheartfailure.115.002919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yukinori Ikegami
- From the Departments of Cardiology (Y.I., T.F., Y.M.) and Endocrinology (R.J.), National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
| | - Tadashi Fukuda
- From the Departments of Cardiology (Y.I., T.F., Y.M.) and Endocrinology (R.J.), National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Rie Jo
- From the Departments of Cardiology (Y.I., T.F., Y.M.) and Endocrinology (R.J.), National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yukihiko Momiyama
- From the Departments of Cardiology (Y.I., T.F., Y.M.) and Endocrinology (R.J.), National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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Laway BA, Ramzan M, Allai MS, Wani AI, Misgar RA. CARDIAC STRUCTURAL AND FUNCTIONAL ABNORMALITIES IN FEMALES WITH UNTREATED HYPOPITUITARISM DUE TO SHEEHAN SYNDROME: RESPONSE TO HORMONE REPLACEMENT THERAPY. Endocr Pract 2016; 22:1096-103. [PMID: 27359291 DOI: 10.4158/ep161262.or] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Data on cardiac abnormalities in females with untreated hypopituitarism are limited. We investigated echocardiographic abnormalities in females with untreated hypopituitarism and their response to treatment. METHODS Twenty-three females with treatment-naïve hypopituitarism and 30 matched healthy controls were evaluated for cardiac structure and function. Echocardiographic evaluation was done at presentation and after achieving a euthyroid and eucortisol state. RESULTS Fourteen (61%) patients had mitral regurgitation, and 11 (48%) had pericardial effusion as against none among controls. Indices of left ventricular (LV) size like LV end diastolic dimension (LVEDD; 44.5 ± 3.5 mm in cases vs. 47.6 ± 3.8 mm in controls, P = .004), and LV diastolic volume (LVEDV; 91.8 ± 18.0 mL versus 106.5 ± 20.4 mL, P = .009) were significantly lower in the SS group compared with controls. LV mass (LVM) was 70.8 ± 19.2 g in cases and 108.0 ± 33.2 g in controls (P = .02). Similarly, indices of LV systolic function like stroke volume (SV; 59.1 ± 12.0 mL in cases and 74.4 ± 15.8 mL in controls; P = .000), ejection fraction (EF; 64.3 ± 6.2 % in cases against 69.9 ± 9.2 % in controls; P = .03), and fractional shortening (FS; 34.9 ± 4.7% versus 40.1 ± 4.4%, P = .000) were significantly decreased in patients compared with controls. Cardiac abnormalities normalized with restoration of a euthyroid and eucortisol state. CONCLUSION Pericardial effusion, mitral regurgitation, and diminished LVM are common in females with untreated hypopituitarism. ABBREVIATIONS ACTH = adrenocorticotrophic hormone BMI = body mass index DT = deceleration time EDV = end-diastolic volume EF = ejection fraction FS = fractional shortening GH = growth hormone IGF-1 = insulin growth factor-1 ITT = insulin tolerance test IVSd = interventricular septal diameter LH = luteinizing hormone LV = left ventricular LVEDD = LV end diastolic dimension LVEDV = LV end diastolic volume LVM = LV mass MRI = magnetic resonance imaging MVP = mitral value prolapse PPH = postpartum hemorrhage PWd = posterior wall diameter SS = Sheehan syndrome SV = stroke volume T3 = triiodothyronine T4 = thyroxine TSH = thyroid-stimulating hormone.
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Kissell N, Mudd JO, Gelow JM, Chong LE, Yuen KC. Cardiogenic Shock Due to Nonischemic Cardiomyopathy Induced by Severe Anterior Hypopituitarism. AACE Clin Case Rep 2015. [DOI: 10.4158/ep14207.cr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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De Giorgi A, Fabbian F, Tiseo R, Parisi C, Misurati E, Molino C, Pala M, Salmi R, Volpi R, Manfredini R. Takotsubo cardiomyopathy and endocrine disorders: a mini-review of case reports. Am J Emerg Med 2014; 32:1413-7. [PMID: 25261397 DOI: 10.1016/j.ajem.2014.07.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/17/2014] [Accepted: 07/26/2014] [Indexed: 01/20/2023] Open
Affiliation(s)
- Alfredo De Giorgi
- Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria (AOU), Ferrara, Italy.
| | - Fabio Fabbian
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Ruana Tiseo
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Claudia Parisi
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Elisa Misurati
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | | | - Marco Pala
- Clinica Medica, Department of Medicine, AOU, Ferrara, Italy.
| | - Raffaella Salmi
- Second Internal Medicine, Department of Medicine, AOU, Ferrara, Italy.
| | - Riccardo Volpi
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
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Fernández Simón I, Alcántara Carmona S, Fernández Muñoz R, Martínez Álvarez L, Rodríguez C, Lipperheide Vallhonrat I. Shock cardiogénico por panhipopituitarismo. Med Intensiva 2014; 38:329-30. [DOI: 10.1016/j.medin.2013.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 04/11/2013] [Accepted: 04/21/2013] [Indexed: 10/26/2022]
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Islam AKMM, Hasnat MA, Doza F, Jesmin H. Sheehan's syndrome with reversible dilated cardiomyopathy: A case report and brief overview. J Saudi Heart Assoc 2014; 26:117-20. [PMID: 24719543 DOI: 10.1016/j.jsha.2014.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 01/13/2014] [Accepted: 01/18/2014] [Indexed: 10/25/2022] Open
Abstract
Sheehan's syndrome is a rare condition characterized by post-partal panhypopituitarism due to necrosis of adenohypophysis resulting from severe post-partum hemorrhage. Lethargy, amenorrhea and failure of lactation are the usual presenting features. Cardiac involvement in Sheehan's syndrome is rare. The case presented here describes dilated cardiomyopathy in a 36-year-old lady who failed to respond adequately to the standard anti-failure treatment. Further investigation revealed the diagnosis of Sheehan's syndrome. Besides other manifestations, cardiac function reverted to normal after giving replacement therapy with glucocorticoid, levothyroxine and sex hormone. Physicians, specially those in developing countries, should have high index of suspicion for the diagnosis of Sheehan's syndrome while dealing with a case of 'peripartal dilated cardiomyopathy'. Persistent amenorrhea and failure of lactation may be important clues in this context. Timely diagnosis and appropriate treatment can lessen the sufferings of the patients.
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Affiliation(s)
| | - Mohammad A Hasnat
- Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka
| | - Fatema Doza
- Department of Radiology & Imaging, National Institute of Cardiovascular Diseases, Dhaka
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Abstract
Pregnancy is associated with normal physiological changes in endocrine system that assists fetal survival as well as preparation of labor. The pituitary gland is one of the most affected organs in which major changes in anatomy and physiology take place. Due to overlapping clinical and biochemical features of pregnancy, sometimes the diagnosis of pituitary disorders may be challenging. It is important to know what normal parameters of changes occur in endocrine system in order to diagnose and manage complex endocrine problems in pregnancy. In our present review, we will focus on pituitary disorders that occur exclusively during pregnancy like Sheehan's syndrome and lymphocytic hypophysitis and pre-existing pituitary disorders (like prolactinoma, Cushing's disease and acromegaly), which poses significant challenge to endocrinologists.
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Affiliation(s)
- Bashir A. Laway
- Department of Endocrinology, Sher I Kashmir Institute of Medical Sciences, Soura Srinagar, Jammu and Kashmir, India
| | - Shahnaz A. Mir
- Department of Endocrinology, Sher I Kashmir Institute of Medical Sciences, Soura Srinagar, Jammu and Kashmir, India
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Affiliation(s)
- Shrenik Doshi
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Bhat MA, Laway BA, Allaqaband FA, Kotwal SK, Wani IA, Banday KA. Acute renal failure: A rare presentation of Sheehan's syndrome. Indian J Endocrinol Metab 2012; 16:306-309. [PMID: 22470876 PMCID: PMC3313757 DOI: 10.4103/2230-8210.93777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sheehan's syndrome occurs as a result of ischemic pituitary necrosis secondary to severe postpartum bleeding. It is one of the most common causes of hypopituitarism, characterized by variable clinical presentation. Acute kidney injury occurs rarely in Sheehan's syndrome and most of the cases have been found to be precipitated by rhabdomyolysis. We here present a case of Sheehan's syndrome with acute kidney injury where theprecipitating cause was chronic hypocortisolemia. We believe this is the first reported case of Sheehan's syndrome in which acute kidney injury was precipitated by adrenal insufficiency.
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Affiliation(s)
- Manzoor A. Bhat
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Bashir A. Laway
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Faheem A. Allaqaband
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Suman K. Kotwal
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Imtiyaz A. Wani
- Department of Nephrology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Khursheed A. Banday
- Department of Nephrology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
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Aggarwal S. RE: Sheehan syndrome with reversible dilated cardiomyopathy. Ann Saudi Med 2010; 30:494; author reply 494. [PMID: 21060164 PMCID: PMC2994175 DOI: 10.4103/0256-4947.72278] [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: 11/17/2022] Open
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