Computed Tomographic Correlation with Pituitary Function in Sheehan`s Syndrome

Abstract

Twenty six patients with Sheehan’s syndrome were studied with high-resolution computed tomography (CT) and the sequential pituitary stimulation test in order to correlate the CT findings of the sella turcica with the pituitary reserve functions. CT revealed 21 completely empty sella (CES), 4 partially empty sella (PES) and 1 normal sella. Panhypopituitarism occurred in 1 of 4 patients with PES and 20 of 21 with CES. One patient showing normal sella had a normal preservation of prolactin (PRL), thyroid stimulating hormone (TSH), follicle stimulating hormone (FSH) and lutenizing hormone (LH). In all patients with PES and CES, growth hormone (GH) responses to hypoglycemia and PRL responses to thyrotropin releasing hormone (TRH) were blunted. Three (75.0%) with PES had normal basal cortisol levels, which were more frequent than two (9.6%) with CES; however, most of the PES (3 of 4) and CES (20 of 21) demonstrated blunted cortisol responses to hypoglycemia. Three (75.0%) with PES and only one (4.8%) with CES had normal thyroxine levels and TSH responses to TRH. None with PES showed decreased basal and stimulated levels of FSH and LH, whereas 15 of 21 with CES did. The pituitary functions of the patients having considerable amounts of pituitary remnants visualized by CT were relatively preserved for TSH, cortisol, FSH and LH. Considering the above results, changes in the amounts of pituitary remnants detected by CT might correlate with hormonal secretory capacity.

Sheehan's Syndrome of More Than 30 Years' Duration: An Endocrine and MRI Study of 6 Cases.

“…ACTH, F, GH and TSH secretory responses were blunted in all patients, and next, most commonly, PRL secretion was involved. Although these results generally agree with previous studies, gonadtropin responses were maintained more often than in previous reports [4,5,21]. This finding is presumed to reflect both surviving gonadotrophs and age-related ovarian hypofunction.…”

“…To a large extent, however, the natural history of 55 has remained unclear, with the more recently described entity of lymphocytic adenohypophysitis raising further questions about the pathophysiology of 55 [16]. Several studies [4][5][6][7][8]17] and case reports [18][19][20] examining the relationship between sellar radiologic findings and endocrine tests in 55 are summarized in Table 5, showing a high frequency of ES, especially complete ES. Lee et al correlated volumes of pituitary remnants shown by CT with hormonal secretory capacity [5].…”

“…Several studies [4][5][6][7][8]17] and case reports [18][19][20] examining the relationship between sellar radiologic findings and endocrine tests in 55 are summarized in Table 5, showing a high frequency of ES, especially complete ES. Lee et al correlated volumes of pituitary remnants shown by CT with hormonal secretory capacity [5]. Furthermore, Bakiri et al, found pituitary remnants significantly more often in patients with disease durations shorter than 9 years [6].…”

Post-partum pituitary insufficiency and livedo reticularis presenting a diagnostic challenge in a resource limited setting in Tanzania: a case report, clinical discussion and brief review of existing literature

“…More common presentations include symmetric enlargement of sellar content (66%), thickening of the pituitary stalk (56%), homogenous enhancement (51%) and occasionally asymmetry of the enlarged sellar content (18%) [17]. This differs from the imaging findings in Sheehan’s syndrome which almost always results in a partially or completely empty sella that may be normal or reduced in size [18,19]. …”

A Case of Sheehan's Syndrome with Panhypopituitarism due to the Impairment of both the Hypothalamus and the Pituitary

“…The MRI of the patient revealing the partially empty sella was compatible with Sheehan's syndrome, since Sheehan's syndrome is mostly caused by pituitary infarction [8][9][10][11][12][13][14][15]. Autoimmune disease such as lymphocytic hypophysitis was ruled out because of negative results of autoantibodies [16].…”