Late-onset Sheehan’s syndrome presenting with rhabdomyolysis and hyponatremia: a case report

Soresi, Maurizio; Brunori, Giuseppe; Citarrella, Roberto; Banco, A; Zasa, Antonino; Bella, Giovanna Di; Giannitrapani, Lydia

doi:10.1186/1752-1947-7-227

Cited by 10 publications

(11 citation statements)

References 12 publications

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“…[31][32][33][34] The electromyogram is also important for assessing whether the injury is a myogenic injury, and the electromyogram results of patients that were observed in our study conformed to the changes in RM. [35] It has been reported that the occurrence of RM in patients with Sheehan's syndrome was associated with severe hyponatremia, [10,19] which is also supported by our regression analysis results. Hyponatremia is the most common form of electrolyte disorder in Sheehan's syndrome, in which the pathogenesis is mainly caused by severe hypothyroidism and glucocorticoid deficiency and involves improper secretion of antidiuretic hormone and hypovolemia.…”

Section: Discussionsupporting

confidence: 90%

Clinical analysis of the serum muscle enzyme spectrum of patients with newly diagnosed Sheehan’s syndrome

et al. 2022

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We investigated the factors associated with serum muscle enzyme elevation in patients with Sheehan’s syndrome. A total of 48 patients who were newly diagnosed with Sheehan’s syndrome were included and divided into 3 groups: Group 1, creatine kinase (CK) ≥ 1000 U/L; Group 2, 140 < CK < 1000 U/L; and Group 3, CK ≤ 140 U/L. Differences in serum muscle enzymes, serum electrolytes, blood glucose and hormones were compared among the 3 groups. A Spearman correlation analysis and multiple linear regression analysis were performed on serum muscle enzymes and the other variables. Four patients in Group 1 underwent electromyography. Fourteen, 26 and 8 patients were divided into Group 1, Group 2, and Group 3, respectively. The levels of plasma osmolality, serum sodium, free triiodothyronine (FT3) and free thyroxine (FT4) in Group 1 were lower than those in Group 3 at admission ( P < .05). There were significant differences in CK, CK-MB, aspartate aminotransferase, lactate dehydrogenase, and alpha-hydroxybutyrate dehydrogenase among the three groups ( P < .05). CK was correlated with serum sodium ( r = −0.642, P < .001), serum potassium ( r = −0.29, P = .046), plasma osmolality ( r = −0.65, P < .001), FT3 ( r = −0.363, P = .012), and FT4 ( r = −0.450, P = .002). Moreover, creatine kinase isoenzyme-MB (CK-MB) was correlated with serum sodium ( r = −0.464, P = .001) and plasma osmolality ( r = −0.483, P < .001). The multiple linear regression showed that serum sodium was independently and negatively correlated with CK ( r = −0.352, P = .021). The electromyogram results supported the existence of myogenic injury. Sheehan’s syndrome is prone to be complicated by nontraumatic rhabdomyolysis, with both a chronic course and acute exacerbation. Serum muscle enzymes should be routinely measured. For patients with CK levels > 1000 U/L, a CK-MB/CK ratio < 6% can be a simple indicator to differentiate rhabdomyolysis from acute myocardial infarction. Abnormal serum muscle enzymes observed in Sheehan’s syndrome may be associated with hypothyroidism and with hyponatremia in particular.

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Section: Discussionsupporting

confidence: 90%

Clinical analysis of the serum muscle enzyme spectrum of patients with newly diagnosed Sheehan’s syndrome

et al. 2022

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“…Rhabdomyolysis can occur as a result of electrolyte abnormalities (hypokalemia, hypophosphatemia, hyponatremia, and hypernatremia) in the setting of endocrine diseases such as diabetes 60–63 , thyroid dysfunction 64, 65 , primary hyperaldosteronism 66 , primary adrenal insufficiency 67 , central diabetes insipidus 68 , postpartum hypernatremia 69 , and pituitary dysfunction 70 . Cases of rhabdomyolysis have also been attributed to electrolyte disturbances (primarily hypokalemia and hyponatremia) in the setting of laxative and diuretic misuse/abuse 71–73 .…”

Section: Acquired Causes Of Rhabdomyolysismentioning

confidence: 99%

Diagnostic evaluation of rhabdomyolysis

2015

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Rhabdomyolysis is characterized by severe acute muscle injury resulting in muscle pain, weakness, and/or swelling with release of myofiber contents into the bloodstream. Symptoms develop over hours to days following an inciting factor and may be associated with dark pigmentation of the urine. Serum creatine kinase and urine myoglobin levels are markedly elevated. The clinical examination, history, laboratory studies, muscle biopsy, and genetic testing are useful tools for diagnosis of rhabdomyolysis, and they can help differentiate acquired from inherited causes of rhabdomyolysis. Acquired causes include substance abuse, medication or toxic exposures, electrolyte abnormalities, endocrine disturbance, and autoimmune myopathies. Inherited predisposition to rhabdomyolysis can occur with disorders of glycogen metabolism, fatty acid beta-oxidation, and mitochondrial oxidative phosphorylation. Less common inherited causes of rhabdomyolysis include structural myopathies, channelopathies, and sickle cell disease. This review focuses on the differentiation of acquired and inherited causes of rhabdomyolysis and proposes a practical diagnostic algorithm.

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“…We found one such case in the literature in which the patient initially presented with rhabdomyolysis (table 3). 29 She was found to be deficient in all of the anterior pituitary hormones and gave a history from many years ago of having had postpartum haemorrhage plus an inability to lactate following birth 29. There is another report of a late diagnosis of Sheehan syndrome causing acute renal failure but with only a mildly elevated CK (table 3).…”

Section: Discussionmentioning

confidence: 99%

A case of severe rhabdomyolysis associated with secondary adrenal insufficiency and autoimmune hepatitis

Kennedy

Nagiah

2019

BMJ Case Rep

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Rhabdomyolysis is a serious and life-threatening condition which has many established causes including endocrine disturbances. Of those, thyroid, adrenal and pituitary deficiencies are the most commonly seen. Most cases of rhabdomyolysis with adrenal insufficiency that have been reported have been primary. Here, we report an encounter with a patient who presented with her second case of severe rhabdomyolysis in the setting of secondary adrenal insufficiency. The cause for corticotropic suppression was most likely autoimmune hypophysitis given the presence of other autoimmune comorbidities including a new diagnosis of autoimmune hepatitis. In addition to her case, we present a brief review of the literature pertaining to cases of rhabdomyolysis attributed to adrenal insufficiency.

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Late-onset Sheehan’s syndrome presenting with rhabdomyolysis and hyponatremia: a case report

Cited by 10 publications

References 12 publications

Clinical analysis of the serum muscle enzyme spectrum of patients with newly diagnosed Sheehan’s syndrome

Clinical analysis of the serum muscle enzyme spectrum of patients with newly diagnosed Sheehan’s syndrome

Diagnostic evaluation of rhabdomyolysis

A case of severe rhabdomyolysis associated with secondary adrenal insufficiency and autoimmune hepatitis

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