Extensive investigation of 114 patients with Sheehan's syndrome: a continuing disorder

Abstract

Objective: Sheehan's syndrome (SS) is a well-known cause of hypopituitarism resulting from postpartum pituitary necrosis. Because of its rarity in Western society, its diagnosis is often overlooked. We aimed to investigate the clinical, laboratory, and radiological aspects of SS in a large number of patients. Study design: A retrospective assessment of the medical records of 114 patients with SS was conducted. In addition, sella turcica volumes of 29 healthy women were compared with those of patients by magnetic resonance imaging examinations. Results: The mean period of diagnostic delay was 19.7 years in patients with SS. It was found that 52.6% of patients had nonspecific complaints, 30.7% had complaints related to adrenal insufficiency, and 9.6% had complaints related to hypogonadism when diagnosed. At the time of diagnosis, 55.3% of the patients had panhypopituitarism, while 44.7% had partial hypopituitarism. The number of deficient hormones was found to be increased over the years. None of the patients whose basal prolactin was below 4.0 ng/ml had adequate prolactin responses to TRH test, while all patients whose basal prolactin was above 7.8 ng/ml had adequate responses. Mean sella volume was found to be significantly lower in the SS group (340.5G214 mm 3 ) than that in the healthy group (602.5G192 mm 3 ). Conclusions: SS is a common cause of hypopituitarism in underdeveloped and developing countries. The main reasons for diagnostic delay seem to be the high frequency of patients with nonspecific complaints and neglect of SS. In addition, the TRH stimulation test was found to have a high sensitivity and specificity to recognize PRL deficiency. Furthermore, small sella size may have an important contributing role in the etiopathogenesis of SS.

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

“…The most consistent finding in SS is the loss of somatotroph and thyrotroph function; though the loss of somatotroph function is universal, there are varying reports about involvement of thyrotroph function. Several previous series reported thyrotroph failure in 90% of patients (6,8,9,13) and one reported it in all the patients (8). All of our patients had thyrotrophs failure.…”

“…Corticotroph involvement has been reported in 50 100% of women in different series (6,7,9). In the present series, 62% of women had preservation of corti cotroph function.…”

“…Previously prolactin deficiency was reported in 85.2% of women with SS on ITT (5). In a recent large series of 114 patients, 37% of women had normal lactation which included 6% of women having a blunted response to TRH test (6). In the present series 9.5% of women had normal lactation and a normal prolactin response to ITT.…”

“…Preservation of gonadotroph function in women with SS has been widely reported in the literature. Loss of go nadotroph function has been reported in all the patient series from Turkey (6,8,9). On the other hand Indian data reveal that preservation of gonadotroph function and subsequent pregnancy is not an uncommon pheno menon (8,17 20).…”

“…Sheehan's syndrome was the sixth common cause of adult growth hormone (GH) deficiency comprising of 3.1% of total patients of adult hypopituitarism, who were administered GH (5). The largest series of patients with SS seen over a period of more than two decades was published recently (6). The clinical presentation of hypopituitarism in SS va ries from subtle symptoms to severe hypocortisol crisis.…”