Sheehan's syndrome: differential diagnosis in the acute phase

Abstract

Dejager S, Gerber S, Foubert L&Turpin G (La Pitié Salpétrière, Paris, France). Sheehan's syndrome: differential diagnosis in the acute phase (Case Report). J Intern Med 1998; 244: 261–66. Many studies have been done in the later course of Sheehan's syndrome, but very few have documented the acute phase with clinical, endocrine and imaging data. We present the case of a young woman complaining of severe headache after delivery, who developed hypopituitarism. Magnetic resonance imaging (MRI) disclosed the presence of an enlarged non haemorrhagic pituitary gland. Follow‐up MRI showed a spontaneous and rapid shrinkage of the pituitary, within 20 days, which appeared as an empty sella 3 months later. Sheehan's syndrome may initially closely mimic hypophysitis, or the necrosis of an adenoma. We discuss the differential diagnoses, important for the best therapeutic management.

A novel hook-shaped enhancement on contrast-enhanced sagittal magnetic resonance image in acute Sheehan’s syndrome: a case report

“…The novel hook-shaped enhancement on sagittal T1WI, to our knowledge, has not been reported so far. Only ring enhancement of the anterior lobe has been reported in the acute phase of Sheehan's syndrome [6][7][8]. We speculate that the characteristic hook-shaped enhancement reflects the complex vasculature of the pituitary gland and the stalk (Fig.…”

“…Thus, the anterior lobe primarily receives blood, through a long series of vessels, from the internal carotid artery and is vulnerable to hypovolemia resulting from massive hemorrhage in this complicated delivery system. In the acute phase of Sheehan's syndrome, a ring enhancement of the anterior lobe on gadolinium (Gd)-enhanced magnetic resonance (MR) image has been reported in some cases [6][7][8]. This reflects a situation wherein blood supply to the marginal zone occurs via the other three vessels, the short portal vein, the capsular artery, and the trabecular artery, but not the long portal vein.…”

Posterior pituitary function in Sheehan’s syndrome

“…The mean age of the controls was 49.1G2.2 years (range 40-72). Laboratory evaluation included basal hormone (fT 3 , fT 4 , thyroid-stimulating hormone (TSH), prolactin (PRL), cortisol, estradiol (E 2 ), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and insulin-like growth factor-I (IGF-I) levels and dynamic pituitary function tests, including TSH and PRL responses to TRH, FSH and LH responses to gonadotropin-releasing hormone (GnRH)), cortisol responses to adrenocorticotropic hormone (ACTH), and growth hormone (GH) and cortisol responses to insulin tolerance test. Eighteen (66.7%) patients had panhypopituitarism and nine (33.3%) had partial hypopituitarism.…”

Pregnancy and pituitary disorders

“…The mean duration between postpartum hemorrhage and clinical manifestations varies from 1 to 33 or 2 to 40 years without a correlation between severity of hypopituitarism and degree of empty sella (195,196). SS detected in the acute phase is rare (197)(198)(199), but most of the SS cases are diagnosed during the early postpartum period in the western countries.…”