Sheehan's syndrome with central diabetes insipidus

Abstract

SUMMARYSheehan's syndrome refers to the occurrence of hypopituitarism after delivery, usually preceded by postpartum hemorrhage. The condition still continues to be a common cause of hypopituitarism in developing countries like India. The disorder usually presents with anterior pituitary failure with preservation of posterior pituitary functions. Posterior pituitary dysfunction in the form of central diabetes insipidus is rare in patients with Sheehan's syndrome. We describe the clinical course of a young lady who after her sixth childbirth developed severe postpartum hemorrhage followed by development of panhypopituitarism which was confirmed by hormonal investigation and demonstration of empty sella on imaging. In addition, she developed Polyuria. SUMÁRIOA síndrome de Sheehan está relacionada à ocorrência de hipopituitarismo pós-parto, geralmente precedido por hemorragia pós-parto. Essa condição clínica ainda constitui causa comum do hipopituitarismo observado em países em desenvolvimento como a Índia. Essa síndrome se caracteriza pela insuficiência da glândula hipofisária anterior, porém com a conservação das funções da glândula hipofisária posterior. A disfunção da hipófise posterior, sob a forma de diabetes insipidus central, é algo raramente observado em pacientes que apresentam a síndrome de Sheehan. Neste artigo, descrevemos o caso de uma jovem que, após o sexto parto, apresentou hemorragia pós-parto grave, seguida pela evolução de pan-hipopituitarismo que foi confirmado por pesquisa hormonal e exames de imagem que evidenciaram sela vazia. A jovem também apresentou poliúria. Os resultados do teste de privação de água e exame de resposta à vasopressina indicaram diabetes insípido central. A paciente fazia uso contínuo de desmopressina para controlar a poliúria. Arq Bras Endocrinol Metab. 2011;55(2):171-4 Descritores Síndrome de Sheehan; diabetes insípido central; teste de privação de água

Clinical, hormonal and radiological features of partial Sheehan’s syndrome: an Indian experience

“…Mid sagital region is least damaged during pituitary infarc tion. Because of dual blood supply to posterior pitui tary, it is likely that these cells escape damage and will be responsible for preservation of some of corticotroph function (22). None of the patients in the present se ries had involvement of posterior pituitary function in the form of polyuria.…”

Cardiogenic Shock Due to Nonischemic Cardiomyopathy Induced by Severe Anterior Hypopituitarism

“…The more subtle manifestations of this syndrome include failure to lactate, oligo-/amenorrhea, involution of breast tissue, and loss of axillary and public hair (3). The cause of panhypopituitarism is thought to result from ischemic necrosis of the anterior pituitary secondary to postpartum hemorrhage (4), hence diabetes insipidus rarely occurs (5,6), even though Sheehan and Whitehead demonstrated lesions in the neurohypophysis and hypothalamic nuclei in over 90% of their patients (7).…”

Recovery of prolactin function following spontaneous pregnancy in a woman with Sheehan′s syndrome

“…[2] Classical as well as some “non-endocrine” features in these women have been reported in areas where the disorder is common. [121314] A significant number of these women present with anemia and other cytopenias, which respond to hormone replacement. [1516] The two important hormone lines universally lost in these women include lactotroph and somatotroph, because of their location in the lower and lateral parts of pituitary and subsequent susceptibility to infarction.…”