Postpartum Necrosis of the Anterior Pituitary

Sheehan, H. L.; Murdoch, R.

doi:10.1016/s0140-6736(00)60421-x

Cited by 73 publications

(44 citation statements)

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“…Sheehan's syndrome, which was originally described by Sheehan in 1937, occurs as a result of ischaemic pituitary necrosis due to severe postpartum haemorrhage (6). The prevalence of Sheehan's syndrome in 1965 was estimated to be 100 -200 per 1 000 000 women (7).…”

Section: Introductionmentioning

confidence: 99%

Sheehan’s syndrome: baseline characteristics and effect of 2 years of growth hormone replacement therapy in 91 patients in KIMS – Pfizer International Metabolic Database

et al. 2005

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Section: Introductionmentioning

confidence: 99%

Sheehan’s syndrome: baseline characteristics and effect of 2 years of growth hormone replacement therapy in 91 patients in KIMS – Pfizer International Metabolic Database

et al. 2005

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“…linical recognition of Sheehan syndrome (hypopituitarism resulting from postpartum pituitary gland infarction after severe hypotension secondary to massive bleeding 1 ) is often insidious, with the diagnosis being delayed for years. 2 Pituitary imaging studies late in the course have revealed atrophy of the gland, resulting in a small empty sella.…”

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confidence: 99%

Sequential Pituitary MR Imaging in Sheehan Syndrome: Report of 2 Cases

Kaplun

Fratila²,

Ferenczi³

et al. 2008

AJNR Am J Neuroradiol

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SUMMARY:We present the evolution of pituitary changes in the cases of 2 patients with Sheehan syndrome as assessed by MR imaging. Both patients had severe postpartum hemorrhage, symptoms of pituitary gland apoplexy, and hypopituitarism. Sequential MR imaging demonstrated evidence of ischemic infarct in the pituitary gland with enlargement followed by gradual shrinkage during several months, to pituitary atrophy. Clinical recognition of Sheehan syndrome (hypopituitarism resulting from postpartum pituitary gland infarction after severe hypotension secondary to massive bleeding 1 ) is often insidious, with the diagnosis being delayed for years. 2Pituitary imaging studies late in the course have revealed atrophy of the gland, resulting in a small empty sella. 3,4 Rarely, patients present with pituitary apoplexy.2 MR imaging studies have been reported in only a few cases. 5,6 We report the cases of 2 patients with Sheehan syndrome with acute presentations, in which the progression of pituitary gland changes was assessed by sequential MR imaging. Case Reports Case 1A 29-year-old woman delivered a full-term baby. The delivery was complicated by retained placenta and profuse bleeding, requiring emergent embolization of the uterine artery. Her hemoglobin level fell to 3.8 g/dL. Several hours later, the patient developed a severe headache and nausea. A routine CT study of her head showed no abnormality. Her symptoms resolved, and she was discharged from the hospital without additional work-up. She returned on day 17 postpartum with fatigue, fever, mild headache, failure to lactate, and postural syncope. Her temperature was 101.2°F, pulse 122, and a supine blood pressure of 90/48 mm Hg. Examination showed skin pallor, a cardiac flow murmur, clear lungs, and a soft abdomen. Laboratory evaluation revealed anemia, mild hyponatremia (sodium, 134 mEq/L), and abnormal pituitary function test results (Table) consistent with panhypopituitarism.MR imaging on postpartum day 26 (Fig 1) revealed a nonenhancing, minimally hypointense lesion in the pituitary gland. MR imaging 6 months postpartum (Fig 2) showed shrinkage of the pituitary gland with CSF signal intensity in the sella ("empty sella"). The pituitary infundibulum and hypothalamus appeared normal. Case 2A 21-year-old woman delivered a full-term healthy baby after labor was induced following premature rupture of membranes. During delivery, she sustained a fourth-degree perineal laceration with severe bleeding and hypotension (blood pressure, 60/30 mm Hg). Her he-

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“…Sheehan sendromu (SS) ya da hipofiz bezinin nekrozu postpartum hemorajinin nadir bir komplikasyonu olarak ilk kez 1937 yılında tanımlanmıştır (1).…”

Section: A Sheehan Case Precipitated By Acute Adrenal Insufficiency Aunclassified