Adrenal crisis precipitated by influenza A led to the diagnosis of Sheehan's syndrome 18 years after postpartum hemorrhage

Taniguchi, Jumpei; Sugawara, Hitoshi; Yamada, Hodaka; Yoshida, Katsuyuki; Kurihara, Ibuki; Yoshida, Masashi; Ishii, Akira; Fukuchi, Takeo

doi:10.1002/ccr3.3355

Cited by 5 publications

(3 citation statements)

References 27 publications

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“…It is known that SIADH is the most common reason for euvolemic hyponatremia. There are clear diagnostic criteria for SIADH, nevertheless it is not always the case that the central adrenal insufficiency is priorly excluded [17][18][19]. Further contribution to the severity of hyponatremia comes from hypothyroidism as a part of hypopituitarism in the presented patient.…”

Section: Discussionmentioning

confidence: 78%

Forgotten cause of severe hyponatremia

et al. 2021

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Introduction. Sheehan syndrome (ShS) is (pan)hypopituitarism because of postpartum pituitary infarction due to massive obstetrical hemorrhage. Enlargement of the pituitary gland, smaller sellar region, disseminated intravascular coagulation (DIC) or autoimmunity are predisposing factors. The absence of lactation after labor and inability to resume the menstrual cycle later are presenting symptoms. Some of patients with Sheehan's syndrome have a sudden onset of severe hypopituitarism immediately after labor, most often in the form of severe hyponatremia. Central adrenal insufficiency is the most usual cause of hyponatremia, although in some cases the syndrome of inappropriate antidiuretic hormone secretion has been also described. Case outline. The female patient, 39-year-old, was admitted to the Intensive Care Unit due to severe hyponatremia with neurological symptoms (Na 103 mmol/L, Cl 72 mmol/L, K 3.7 mmol/L), and absence of lactation. Previously, on the sixth postpartum day, she was admitted to the Obstetrics and Gynecology Clinic due to severe headache, nausea, vomiting, and blurred vision. The symptoms persist from the labor, which was complicated with severe hemorrhage (1000 ml) due to obstetric complications. Treatment began with the 3% hypertonic saline solution with restriction of fluid intake. In regard to panhypopituitarism, replacement therapy with hydrocortisone and levothyroxine was initiated. Diabetes insipidus was excluded. Growth hormone replacement therapy and combination of progesterone and progestogens was started during follow-up. Conclusion. Early diagnosis of Sheehan's syndrome is essential. Pituitary insufficiency in these patients has a great diversity in presentation, that can sometimes result in coma and death.

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Section: Discussionmentioning

confidence: 78%

Forgotten cause of severe hyponatremia

et al. 2021

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“…Los pacientes requieren un suministro continuo de las hormonas que ya no pueden ser producidas por la pituitaria dañada, como las hormonas tiroideas, las suprarrenales y las sexuales (Fernández et al, 2020;Tzvi et al, 2019). Un aspecto crítico del tratamiento es la necesidad de iniciar la terapia con glucocorticoides antes de administrar hormonas tiroideas para evitar una posible crisis suprarrenal (Schury y Adigun, 2017;Taniguchi et al, 2020).…”

Section: Abordaje Terapéutico En El Síndrome De Sheehanunclassified

“…Este fármaco actúa como un agente antifibrinolítico y no es teratogénico. Además, se ha observado que la falta de un diagnóstico correcto puede llevar a algunos pacientes a vivir años sin tratamiento, hasta que una crisis suprarrenal los lleva a ser diagnosticados adecuadamente mediante pruebas complementarias (Taniguchi et al, 2020).…”

Section: Abordaje Terapéutico En El Síndrome De Sheehanunclassified

Actuación de enfermería ante el Síndrome de Sheehan en pacientes: una revisión bibliográfica

Espinoza Loja

2024

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Se busca determinar la prevalencia y los factores de riesgo del Síndrome de Sheehan, así como explorar los abordajes terapéuticos, identificar complicaciones frecuentes y evaluar intervenciones de enfermería. Se efectuó una revisión de 50 artículos seleccionados por su relevancia. La prevalencia registrada es de 14 millones de casos de hemorragia posparto anualmente, con una incidencia global del Síndrome de Sheehan de 1 en 100,000 nacimientos. El embarazo y la subsiguiente hemorragia posparto se presentan como los principales factores precipitantes. El tratamiento eficaz requiere un reemplazo hormonal permanente. Las complicaciones clave incluyen la agalactia, la amenorrea y el hipopituitarismo. Las intervenciones de enfermería se centran en el manejo de los síntomas y la implementación del Proceso de Atención de Enfermería (PAE). La hemorragia posparto que excede los 1000 ml de pérdida sanguínea, con una reposición insuficiente de volumen, es un antecedente común en las pacientes con el síndrome de Sheehan.

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