Postpartum Hypopituitarism Research Articles

Unveiling a syndrome through recurrent hypoglycemia

Post-partum hypopituitarism, widely known as Sheehan syndrome, is an ischemic necrosis of the pituitary gland. This event is the result of profound hypotension that is usually caused by massive bleeding or less often in disseminated intravascular coagulation in the peripartum or more frequently during the postpartum period. The sequelae of this catastrophic event are generally subtle, with varying degrees of anterior pituitary hormonal deficiency. Despite this syndrome decreasing worldwide, some cases are occasionally diagnosed in underdeveloped countries because of the improvements and advances in obstetric overall care, and the long-standing experience and recognition of the syndrome, especially in developed countries. The syndrome often progresses slowly; therefore, clinicians face great challenges in making early diagnoses. The most distinctive feature is usually the history of postpartum bleeding, with failure of lactation, cessation of menstruation, and ill-health with vague symptoms that jeopardize the quality of the patient’s life. We had handled a young lady with previously mentioned symptoms but with striking bouts of recurrent hypoglycemia, especially during long fasting. The early noticeable constellation of symptoms and signs with classical history can facilitate early diagnosis, alleviate morbidity and mortality, and improve the overall quality of the patient's life. Most patients will lead a normal life after they have a timely diagnosis and receive the optimal hormonal substitutions.

6705 Sheehan syndrome: a case report

Abstract Disclosure: F.S. Rodrigues: None. C.C. Silva: None. W. Da Silva: None. T.M. Caldas: None. L. Rocha: None. Introduction: Sheehan's Syndrome, or postpartum hypopituitarism, is characterized by hyperplasia and an increase in the number of prolactin-secreting cells, secondary to a major hemorrhagic event occurring during or after childbirth. In this situation, the anterior pituitary gland can increase in size and suffer ischemia due to vascular hypoflow. Consequently, there is low production of one or more of the hormones produced by the gland, which can generate heterogeneous clinical presentations. As a preventive treatment, polytransfusion is recommended in cases of large hemorrhage. OBJECTIVE: To present a case of Sheehan’s Syndrome, which developed after a birth complicated by a major hemorrhagic event, even after receiving polytransfusion. CASE REPORT: A woman, 45 years old, being monitored at the endocrinology outpatient clinic for 2 years. As a history, there was a severe hemorrhage during her cesarean section, which occurred 30 years ago, in which she received a blood transfusion of a total of 1.2 liters of packed red blood cells. 7 years ago, she was diagnosed with hypothyroidism and 2 years ago with hyperprolactinemia. In 2022, she was also diagnosed with adrenal insufficiency. At that time, she underwent a magnetic resonance imaging (MRI) scan of the sellaturcica region, which was found to be partially empty. The patient's recent exams showed TSH: 3.15 μUI/mL (0.4-4.0); Free T4: 0.88 ng/dL (0.93-1.7); Cortisol 8h: 8 μg/dL (5-25); LH: 15 mIU/mL (1.1-14.7); FSH: 43 mIU/mL (2.8-9); Estradiol: 8 ng/dL (12.4-398); Prolactin: 28 ng/mL (1.9-25), basal GH 0’ 0.054/30’ 2.51/60’ 2.48/90’ 3.74 ng/mL (up to 10), ACTH 17 pg/mL (up to 46). Since then, she has been undergoing endocrinological monitoring for hormone replacement therapy to treat the hormonal changes caused by late-diagnosed Sheehan Syndrome. DISCUSSION: Sheehan's Syndrome is a rare disease, characterized by low blood flow and necrosis of the pituitary gland due to postpartum hemorrhage. The diagnosis results from obtaining a good clinical history associated with hormonal levels. This patient presented significant bleeding after cesarean section requiring transfusions. However, despite transfusions, the patient developed hypothyroidism, hyperprolactinemia, and adrenal insufficiency. The MRI confirmed the suspected diagnosis, showing the partially empty sellaturcica. Conclusion: The diagnosis of Sheehan Syndrome is based on very broad clinical manifestations, with MRI of the sellaturcica contributing to confirming the diagnosis. Although the preventive treatment is blood transfusion, the patient developed the disease, highlighting the need for continued monitoring of pregnant women with a history of significant bleeding during childbirth. Therefore, outpatient monitoring of the patient is necessary with a focus on hormonal levels so that clinical complications are avoided. Presentation: 6/2/2024

Panhypopituitarism due to Sheehan’s Syndrome in a Patient with Recurrent Hyponatremia: Case Report from Nepal

Introduction: Panhypopituitarism, deficiency of all pituitary hormones (anterior pituitary hormones: adrenocorticotropic hormone, thyroid-stimulating hormone, luteinizing hormone, follicle-stimulating hormone, prolactin, growth hormone; posterior pituitary hormones: oxytocin, vasopressin). Sheehan’s syndrome also known as postpartum hypopituitarism is one of the causes of panhypopituitarism, which is characterized by hypopituitarism due to necrosis of pituitary gland secondary to massive postpartum hemorrhage. In this case, a 50 years female presented with the history of vomiting and loss of appetite since 2 years with severe hyponatremia, and decreased pituitary hormones levels in laboratory findings with significant obstetric history is diagnosed with Sheehan’s Syndrome.

A RARE CASE OF SHEEHAN'S SYNDROME .

Sheehan's syndrome is postpartum hypopituitarism caused by necrosis of the pituitary gland.(1) It is rare complication which occurs in 1 out of every 100,000 births globally and is the most common cause of hypopituitarism in low- or middleincome countries [2, 3]. It is reported that Sheehan's syndrome accounts for 0.5% of all known cases of hypopituitarism in females [4]. The disease is deemed “rare” in industrialized nations, but in developing nations, due to a lack of access to sophisticated medical procedures, skilled professionals, and medical resources, which contributes to a higher prevalence of postpartum hemorrhage and subsequent Sheehan's syndrome, it is said to occur in 5 out of every 100,000 births [5, 6]. The prevalence is much higher in developing countries, with a prevalence as high as 3.1% in a state in India where more than half of the affected individuals had home deliveries [7]. The underlying process leading to Sheehan's syndrome is the infarction of the physiologically enlarged anterior pituitary lobe (due to hyperplasia of prolactin secreting cells as a result of elevated estrogen secretion) and secondary to the compression of the blood vessels supplying the gland by the enlarged gland itself or due to grossly decreased blood.

ODP332 Maternal Central Diabetes Insipidus Immediately after Delivery, Owing to Vasospasm of the Internal Carotid Artery

Abstract Background Sheehan's syndrome is a cause of hypopituitarism during the postpartum period, but it rarely manifests immediately after birth. Clinical Case We report the case of a 30-year-old woman who delivered her second child, lost 1,050 mL of blood in the process, but did not receive a blood transfusion. A few hours after delivery, the patient complained of headache, nausea, and thirst, and her urine production increased to 9 L/day. No menstrual irregularities or abnormalities during pregnancy or childbirth had been reported. None of hypotension, external eye muscle paralysis, or visual impairment were identified on physical examination. The laboratory findings were low urine osmolality and high serum osmolality and sodium concentration. The concentrations of thyroid hormones, growth hormone (GH), and anti-diuretic hormone (ADH) were found to be low. The IgG4 concentration was not high (4.7 mg/dL; normal <105 mg/dL) and the patient was negative for anti rabphilin-3A antibody. Pituitary magnetic resonance imaging (MRI) on the day of admission showed enlargement of the pituitary gland and stalk, and magnetic resonance angiography showed stenosis of the left internal carotid artery. The patient showed a poor response to GH-releasing peptide 2 and thyroid releasing hormone stimulation. Hypertonic saline administration did not cause an increase in ADH concentration. We diagnosed adult growth hormone deficiency (aGHD), central hypothyroidism, and central diabetes insipidus (DI). The enlargement of the pituitary gland was slightly less marked and the stenosis of the left internal carotid artery improved 7 days after admission. After 6 months, the pituitary gland was almost normal in size, although the aGHD, central hypothyroidism, and central DI remained. Sheehan's syndrome or lymphocytic hypophysitis could have been responsible for the postpartum hypopituitarism. This case was not typical of lymphocytic hypophysitis with respect to the hormone deficiency pattern, the MRI findings, and the lack of anti rabphilin-3A antibody. Sheehan's syndrome is caused by ischemic necrosis of the anterior pituitary gland after severe postpartum hemorrhage. The prevalence of central DI is estimated to be 2%–3%. Typically, pituitary dysfunction progresses slowly and develops several years after childbirth. In contrast, in the present patient, stenosis of the left internal carotid artery developed and improved during short periods of time. The vasospasm of the internal carotid artery caused reductions in flow through the superior and inferior hypophysial arteries, which resulted in ischemia and necrosis of the pituitary gland, similar to Sheehan's syndrome. Clinical Lesson: Although rare, maternal central DI can be caused by ischemia and vasospasm immediately after the delivery of a child. The possibility of a pituitary stroke in the presence of neoplastic disease should not be ruled out, and imaging and pituitary gland function should be followed over the long term. Presentation: No date and time listed

Anesthetic challenges in a case of Sheehan's syndrome posted for open reduction and internal fixation and nailing following fracture femur

Sheehan's syndrome is postpartum hypopituitarism caused by necrosis of the pituitary gland due to severe hypotension or shock caused by massive hemorrhage during or after delivery. Patients with Sheehan's syndrome have varying degrees of pituitary hormone deficiency. There is increased sensitivity to barbiturates and opiates in patients with Sheehan's syndrome. They are more prone to hypotension, hypoxia, and hypothermia which must be addressed intraoperatively. Herein, we report successful anesthetic management of a patient with Sheehan's syndrome with distal third femoral shaft fracture for fixation who had numerous hormonal and electrolyte abnormalities. This case report emphasizes the importance of meticulous preanesthetic assessment, optimization, and perioperative management of patients with Sheehan's syndrome for successful management of the case.

Evaluation of bone texture imaging parameters on panoramic radiographs of patients with Sheehan's syndrome: a STROBE-compliant case-control study.

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. 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). 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). 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.

Unusual Presentation of Sheehan’s Syndrome with Severe Hyponatremia and Recurrent Symptomatic Hypoglycemia: A Case Report

Sheehan's syndrome (SS) is postpartum hypopituitarism caused by necrosis of the pituitary gland. The onset in most cases is several months or even years after the inciting delivery, so it is often unrecognized and not adequately treated. Because SS often evolves slowly, it is usually diagnosed late. We report a 47-year old woman with loss of consciousness. Fourteen years ago, she had postpartum hemorrhage with subsequent amenorrhea and failure to lactate. Laboratory investigation showed low blood sugar and serum sodium levels, amid normal cortisol and thyroid function tests. Magnetic resonance imaging (MRI) of the pituitary revealed an empty sella consistent with SS. The presentation of hypoglycemia and hyponatremia are less known complications of Sheehan's syndrome with only a few documented in case reports.

Recurrent Ventricular Tachycardia in Sheehan’s Syndrome

Sheehan’s syndrome (SS) is postpartum hypopituitarism, usually secondary to postpartum hemorrhage (PPH) and shock (1). This syndrome is rare in industrialized nations, but it is still a major threat to women’s health in developing countries including India (2). SS presents with combined anterior pituitary hormone deficiency, although selective preservation of anterior pituitary function has been documented (3). SS presenting as ventricular tachycardia is rare with few reports in the literature (4,5). We here present a case of SS who presented to the emergency department with syncope. Electrocardiogram (ECG) revealed ventricular tachycardia, which did not recur after the patient was started on hormone replacement therapy. Case Report

Sheehan Syndrome: a Rare Complication of Post-partum Hemorrhage

Incidence of Sheehan syndrome, also known as post-partum hypopituitarism or post-partum pituitary insufficiency or hypopituitarism syndrome has reduced markedly but it does occur in under-developed countries with a reported incidence of 1:10000 deliveries.1-3 We are reporting the case of a 22 year old female with Sheehan syndrome occurring after massive post-partum hemorrhage. DOI: http://dx.doi.org/10.3126/njog.v9i2.11766

Usefulness of pituitary antibodies in the management of non-tumoral pituitary diseases in Tunisian adults

Event Abstract Back to Event Usefulness of pituitary antibodies in the management of non-tumoral pituitary diseases in Tunisian adults Lilia Laadhar1*, Malika Chihaoui2, Maryam Kallel-Sellami1, Nadia Sassi1, Bochra Ftouhi2, Houria Lahmar1, Faouzi Kanoun2, Hedia Slimane2 and Sondes Makni1 1 Immunology Department, La rabta hospital, Tunisia 2 La Rabta hospital, Endocrinology, Tunisia Purpose: Pituitary antibodies (PAs) are directed against cells of the anterior and the posterior lobes of the pituitary gland. The aim of our study was to assess the usefulness of PAs in the management of non-tumoral pituitary diseases in Tunisian adults. Subjects and methods: In this prospective study, we recruited 43 cases of non-tumoral pituitary pathologies. PAs were detected by indirect immunofluoresence on monkey pituitary gland. Results: Patients were 41 women and 2 men, mean age 43.5 ± 12.8 years. APs were positive in 12 patients (28%), 4 APs were directed against the anterior lobe and 10 against the posterior lobe of pituitary gland (2 patients had APs against anterior and posterior lobe at the same time). Twenty one women had a postpartum hypopituitarism suggestive of a Sheehan syndrome, 7 among them had PAs. Fifteen patients had a hypopituitarism without Sheehan syndrome and without malignancy (according to the MRI of the pituitary gland), 3 of them were APs positive. Seven patients had autoimmune polyendocrinopathy and only 3 of them had hypopituitarism. In this last group APs were positive in 4 cases. APs were more frequently detected in patients with autoimmune polyendocrinopathy than others but the difference was not statistically significant. Conclusion: Despite the low number of our patients, we reported a high prevalence of APs in non-tumoral pituitary diseases even in a context of a non autoimmune hypophysitis confirming the poor specificity of these antibodies. Additional studies are needed to identify more reliable marker for the diagnosis of lymphocytic hypophysitis. Keywords: Autoantibodies, Pituitary Gland, lymphocytic hypophysitis, Hypopituitarism, diagnostic Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Immune-mediated disease pathogenesis Citation: Laadhar L, Chihaoui M, Kallel-Sellami M, Sassi N, Ftouhi B, Lahmar H, Kanoun F, Slimane H and Makni S (2013). Usefulness of pituitary antibodies in the management of non-tumoral pituitary diseases in Tunisian adults. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.00265 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 12 Mar 2013; Published Online: 22 Aug 2013. * Correspondence: Dr. Lilia Laadhar, Immunology Department, La rabta hospital, Tunis, Tunisia, lilia_laadhar@yahoo.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Lilia Laadhar Malika Chihaoui Maryam Kallel-Sellami Nadia Sassi Bochra Ftouhi Houria Lahmar Faouzi Kanoun Hedia Slimane Sondes Makni Google Lilia Laadhar Malika Chihaoui Maryam Kallel-Sellami Nadia Sassi Bochra Ftouhi Houria Lahmar Faouzi Kanoun Hedia Slimane Sondes Makni Google Scholar Lilia Laadhar Malika Chihaoui Maryam Kallel-Sellami Nadia Sassi Bochra Ftouhi Houria Lahmar Faouzi Kanoun Hedia Slimane Sondes Makni PubMed Lilia Laadhar Malika Chihaoui Maryam Kallel-Sellami Nadia Sassi Bochra Ftouhi Houria Lahmar Faouzi Kanoun Hedia Slimane Sondes Makni Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

A Patient with Postpartum Hypopituitarism (Sheehan's Syndrome) Developed Postpartum Autoimmune Thyroiditis (Transient Thyrotoxicosis and Hypothyroidism): A Case Report and Review of the Literature

A 36-year-old woman with postpartum hypopituitarism (Sheehan's syndrome: SS) developed postpartum autoimmune thyroiditis (PPAT). She delivered a baby by Caesarean section (620 mL blood loss). At 1 month post partum, she developed thyrotoxicosis due to painless thyroiditis (autoimmune destructive thyroiditis). She was positive for antithyroid antibodies. Postpartum and hypoadrenalism-induced exacerbation of autoimmune thyroiditis caused the thyrotoxicosis due to autoimmune destructive thyroiditis. ACTH was undetectable. She had ACTH deficiency and secondary hypoadrenalism. Hydrocortisone was started. At 6 months post partum, she was referred to us with hypothyroidism. Thyroxine was administered. She had thyrotoxicosis at 1-2 months post partum and then hypothyroidism. She was diagnosed with PPAT. She had hypopituitarism, ACTH deficiency (secondary hypoadrenalism), low prolactin with agalactia, and low LH with failure to resume regular menses. She had empty sella on MRI. She was diagnosed with SS. Three cases with SS have been reported to develop PPAT. Postpartum immunological rebounds and hypoadrenalism-induced immunological alterations (or a combination of the two) might have been responsible for the PPAT.

Sheehan's syndrome: Newer advances.

Sheehan's syndrome (SS) is postpartum hypopituitarism caused by necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery. Patients with SS have varying degrees of anterior pituitary hormone deficiency. Its frequency is decreasing worldwide and it is a rare cause of hypopituitarism in developed countries owing to advances in obstetric care. However, it is still frequent in underdeveloped and developing countries. SS often evolves slowly and hence is diagnosed late. History of postpartum hemorrhage, failure to lactate and cessation of menses are important clues to the diagnosis. Early diagnosis and appropriate treatment are important to reduce morbidity and mortality of the patients.

Spontaneous Pregnancy and Delivery in a Patient with Sheehan's Syndrome

Sheehan's syndrome is postpartum hypopituitarism due to the necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery. Patients with Sheehan's syndrome have varying degrees of anterior pituitary hormone deficiency. They are accompanied with amenorrhea and ovulation dysfunction, and so they rarely get pregnant naturally. Ovulation induction is necessary if these patients desire to become pregnant. However, spontaneous pregnancy may be possible in some patients who have a preserved gonadotrophin reserve. We experienced a case of 29-year-old woman who was diagnosed Sheehan's syndrome 20 months after delivery and we medicated her with prednisolone and thyroxine. She got pregnant spontaneously after 18 months of hormone replacement therapy although she had amenorrhea and irregular menstrual cycles. She successfully delivered a baby by cesarean section. Here we report on this case with a review of the relevant literature concerned with pregnancy and Sheehan's syndrome.

Petrified auricular cartilages pointing the diagnosis of post-partum hypopituitarism in an encephalopathic patient

True ossification of ear auricles is exceptional. We present the first case linking this finding to post-partum hypopituitarism. A 57-year-old female presented with a 2-day history of fever, headache and behavioural disturbances. Brain magnetic resonance imaging was normal. Since cerebral spinal fluid could not be obtained, she was treated empirically for a meningitis. A urinary tract infection was subsequently identified as the cause of fever but when she improved she remained apathetic. At this time petrified auricles were noticed; histological examination revealed true ossification. Endocrinological screening showed partial hypopituitarism and thyroid autoimmune disorder. Initial symptoms could be dated to the birth of her last child 15 years before, with breast feeding difficulties, loss of body hair, and transient amenorrhoea. The absence of overt peripartum bleeding, resumption of menses 1 year later, preservation or recovery of some hypophyseal function, and presence of an associated autoimmune thyroid disorder and of hypophyseal tissue in a normal sella turca, all suggest lymphocytic hypophysitis rather than Sheehan syndrome as the primary disorder. Of the 15 patients reported to date with auricular ossification, two had Addison disease. The present case suggests that low cortisol is the key factor in this clinical finding.

Investigation of the skin characteristics in patients with severe GH deficiency and the effects of 6 months of GH replacement therapy: a randomized placebo controlled study

The presence of GH receptor in human skin and its appendages suggests a direct effect of GH on skin characteristics. The skin is usually thin and dry in patients with GH deficiency (GHD). Sheehan's syndrome classically refers to postpartum hypopituitarism and GH is one of the earliest pituitary hormones lost. While severe GHD is a well-established feature of Sheehan's Syndrome, skin characteristics and the effects of GH replacement therapy (GHRT) have been investigated neither in Sheehan's syndrome nor in other disorders of GHD. The aim of this study was to investigate the skin characteristics, including the sebum content, hydration (skin capacitance), transepidermal water loss (TEWL), pH and skin temperature, and particularly the effects of 6 months of GHRT on these parameters in GH deficient patients with Sheehan's syndrome. Sixteen severely GH deficient women with Sheehan's syndrome (48.1 +/- 10.9 years), and 20 age and menopausal status similar women as control subjects were included. Ten patients received recombinant GH for 6 months (treatment group) and 6 patients received placebo (placebo group) during this period. Skin properties were measured at baseline and after 6 months of GHRT using noninvasive and well-established measuring methods. At baseline the skin capacitance was significantly decreased on the forehead and forearm, and sebum content was significantly decreased on forehead in patients with Sheehan's syndrome compared to control subjects (P < 0.05). In the treatment group there was a significant increase in sebum content on forehead after 6 months of GHRT compared to the baseline value (P < 0.05). However there were no significant changes in other parameters including sebum content on the forearm, TEWL, Ph, skin capacitance and temperature of both the forearm and forehead. In the placebo group there were no changes in any of the evaluated parameters after 6 months of treatment compared to baseline values. The present study clearly shows that the sebum content on the forehead and skin hydration of the forehead and forearm are significantly decreased in GH deficient patients with Sheehan's syndrome. However 6 months of GHRT significantly increased only the sebum content on the forehead. These data suggest that GH and/or IGF-I may have a modulatory role on several skin characteristics.

Effects of 18-month of growth hormone (GH) replacement therapy in patients with Sheehan’s syndrome

Objective Growth hormone deficiency (GHD) in adults is associated with abnormal body composition, altered lipid profile, reduced quality of life and osteoporosis. Replacement with recombinant GH results in significant improvements in most of these altered parameters. The most common cause of adult GHD in previous studies was due to pituitary tumors or their treatment. Sheehan’s syndrome classically refers to postpartum hypopituitarism due to pituitary necrosis occurring secondary to massive bleeding at or just after delivery. While severe GHD is a well-established feature of Sheehan’s syndrome, the effects of Growth hormone replacement therapy (GHRT) in these patients has not been extensively investigated. The present study was therefore designed to investigate the effects of GHD and GHRT in patients with Sheehan’s syndrome. Design The study comprised 14 severely GH-deficient patients with Sheehan’s syndrome with a mean age of 49.4 ± 7.9 yr. Treatment with GH was started at a dose of 0.15 mg per day in month 1, was increased to 0.30 mg per day in month 2, and was maintained at 0.66 mg per day until the end of month 18. With the similar maintenance dose adequate age adjusted IGF-I levels for each patient has been achieved. Blood pressure, lipid profile, biochemical parameters, anthropometric measurements including body mass index (BMI), waist and waist to hip ratio (W/H), and bone mineral density (BMD) were investigated before and at 3, 6, 12 and 18 months of the GHRT. Results The duration of GHD from the onset of the disease was 19.4 ± 1.6 yr. The majority of the patients (78%) had panhypopituitarism. At baseline mean total cholesterol, LDL-cholesterol and triglyceride levels were higher than the normal reference ranges but HDL-cholesterol levels were within the lower normal range. During the treatment period total cholesterol and LDL-cholesterol levels decreased and HDL-cholesterol levels increased significantly ( P < 0.05). Waist circumference and waist to hip ratio were decreased significantly during the GHRT when compared to basal measurements ( P < 0.05). There was a significant positive correlation between the basal waist circumference and the duration of GHD ( P < 0.05). Conclusions This study clearly demonstrates that Sheehan’s syndrome is characterized by severe and long-standing GHD. GHRT have beneficial effects in several parameters including lipid profile and waist circumference. But we could not observe any improvement in BMD after 18 months of GHRT. However interpretations of the present results need to be made with caution because of the uncontrolled design. Further placebo controlled studies with high number of patients with Sheehan’s syndrome are warranted.

A Case of Postpartum Hypopituitarism Accompanied by Cushing's Syndrome as a Result of an Adrenocortical Carcinoma

Sheehan's syndrome frequently causes hypopituitarism either immediately or after a delay of several years, depending on the degrees of postpartum ischemic pituitary necrosis. A 55 year-old woman whose last child was born 27 yr ago with massive hemorrhage was diagnosed as postpartum hypopituitarism. She had deficiency of growth hormone, prolactin, gonadotropins and thyrotropin. However, she interestingly had apparent hypercortisolism without suppression response to the dexamethasone tests. We found an adrenal mass with distant metastases to the liver and lung while investigating the origin of the hypercortisolism. Hyperandrogenism and very high levels of 17alpha hydroxyprogesterone were present. Accordingly, the patient was diagnosed as hypopituitarism due to Sheehan's syndrome accompanied by Cushing's syndrome as a result of an adrenocortical carcinoma.

Spontaneous pregnancy in a patient with Sheehan’s syndrome

Sheehan’s syndrome (postpartum pituitary necrosis) is possibly the most common cause of anterior pituitary insufficiency in developing countries. Hypopituitarism caused by necrosis of physiologically enlarged pituitary gland of pregnancy following postpartum hemorrhage was first described by Sheehan [ [1] Sheehan H.L. The incidence of postpartum hypopituitarism. Am. J. Obstet. Gynecol. 1954; 68 ([abstract]): 202-223 Abstract Full Text PDF PubMed Scopus (24) Google Scholar ]. Classically, it presents with failure of lactation, rapid breast involution, amenorrhea, loss of pubic or axillary hair, skin depigmentation, hypopituitarism and hypoadrenalism [ [1] Sheehan H.L. The incidence of postpartum hypopituitarism. Am. J. Obstet. Gynecol. 1954; 68 ([abstract]): 202-223 Abstract Full Text PDF PubMed Scopus (24) Google Scholar ]. But the pituitary necrosis accompanying Sheehan’s syndrome is not always complete and in some patients there may be selective loss of hormone secretion [ [2] Özbey N. İnanc S. Aral F. et al. Clinical and laboratory evaluation of 40 patients with Sheehan’s syndrome. Isr. J. Med. Sci. 1994; 30: 826-829 PubMed Google Scholar ]. Thus, subsequent pregnancy may be possible if gonadotropin function is preserved [ [3] Morcira A.C. Maciel M.Z. Poss M.C. et al. Gonadotropin secretory capacity in a patient with Sheehan’s syndrome with successful pregnancies. Fertil. Steril. 1984; 42: 303-305 PubMed Google Scholar ]. Here, we report a 38-year-old woman with Sheehan’s syndrome who became pregnant with a successful outcome.

Pituitary autoimmunity in patients with Sheehan's syndrome.

Postpartum hemorrhage (PPH) is a frequent complication of pregnancy in India. Sheehan's description of postpartum hypopituitarism promoted the belief that PPH leads to necrosis of the enlarged pituitary gland of pregnancy and hypopituitarism. However, slow clinical progression suggests factors other than ischemia in its pathogenesis. Tissue necrosis could release sequestered antigens, triggering autoimmunity of the pituitary and delayed hypopituitarism in Sheehan's syndrome. Twenty-six consecutive patients with postpartum hypopituitarism were studied, 19 with Sheehan's syndrome based on a history of PPH and hormone profile suggesting pituitary failure [mean (SD) age 32.7 +/- 6.4 yr, duration of illness 5.5 +/- 3.1 yr], and seven patients with no history of PPH, categorized as "Other." Pituitary imaging and basal T(4), TSH, cortisol, LH, FSH, 17beta-estradiol, and autoantibodies against pituitary (PitAb) and thyroid (TMA) were evaluated. Controls included 28 healthy females without prior conception (22 +/- 5 yr) and 28 with prior conception (26 +/- 5 yr). Twelve of 19 (63.1%) patients with Sheehan's syndrome and one of seven in the Other group had PitAb against the 49-kDa autoantigen; neuron-specific enolase. Four of 28 (14.2%) controls without prior conception and 5 of 28 (17.8%) controls with prior conception had PitAb positivity (P < 0.001 and <0.01 vs. Sheehan's syndrome, respectively). There was no significant difference in the mean serum hormone values and TMA positivity between patients with Sheehan's syndrome and the Other group as well as patients with or without PitAb positivity. Pituitary autoimmunity may play a role in the cause of hypopituitarism following PPH.