Sheehan’s syndrome with pancytopenia—complete recovery after hormone replacement (case series with review)

Laway, Bashir Ahmad; Bhat, Javid Ahmad; Mir, Shabir Ahmad; Khan, Raja Sultan Zaman; Lone, Mohd Iqbal; Zargar, Abdul Hamid

doi:10.1007/s00277-009-0804-9

Cited by 29 publications

(29 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We reviewed nine cases by using Medline search ( Table 2). Six of these cases were associated with Sheehan syndrome [4][5][6][7][8][9], one was associated with macroprolactinoma [10], and one with hypothalamic glioma and one with suprasellar germinoma [11,12]. To the best of our knowledge, this is the first case of pancytopenia secondary to hypopituitarism.…”

Section: Discussionmentioning

confidence: 81%

Pancytopenia Associated with Hypopituitarism in an Acromegaly Patient: A Case Report and a Review of the Literature

et al. 2012

View full text Add to dashboard Cite

We present the case of a patient with acromegaly who had pancytopenia with hypopituitarism secondary to the excision of a pituitary macroadenoma and radiation therapy. A 28-year-old man presented with pancytopenia and serum electrolyte abnormalities. He was diagnosed with acromegaly and underwent surgery and gamma-knife radiotherapy for a pituitary macroadenoma at the age of 22 years. A recent brain magnetic reso nance imaging showed an empty sella, and the basal hormonal profile demonstrated deficiencies of pituitary hormones except thyrotropin. As presenting pancytopenia, his bone marrow biopsy showed hypocellular marrow. The total number of hemocytes increased after hydrocortisone replacement. Hypopituitarism was a possible cause of pancytopenia, and glucocorticoids had crucial effects on converting pancytopenia to normal in this case. (Endocrinol Metab 27:308-313, 2012)

show abstract

Section: Discussionmentioning

confidence: 81%

Pancytopenia Associated with Hypopituitarism in an Acromegaly Patient: A Case Report and a Review of the Literature

et al. 2012

View full text Add to dashboard Cite

show abstract

“…1 Three women (aged 22, 30, and 34 years) with pancytopenia that developed 2-8 years following delivery, 2 as well as a 55-year-old woman with Sheehan's syndrome and isolated anemia, 3 also demonstrated complete resolution of bone marrow abnormalities with glucocorticoid and thyroid hormone replacement therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Of these, the majority (15 of 21, [1][2][3][5][6][7][8]10,[17][18][19][20][21][22][23] ) were reports of Sheehan's syndrome, a condition that occurs in women as a result of anterior pituitary hemorrhage and subsequent necrosis in the setting of hypotension due to blood loss during or after childbirth. In contrast, our patient was a 60-year-old man whose panhypopituitarism was secondary to a pituitary adenoma.…”

Section: Discussionmentioning

confidence: 99%

“…Panhypopituitarism refers to a deficiency of the five hormones produced in the anterior pituitary and released from the hypothalamus: somatotropin (growth hormone [GH] January 13, 2015 between bone marrow health and the pituitary seems likely, given the rapid resolution of hematologic abnormalities with hormone replacement therapy. [1][2][3][4][5][6][7][8][9][10] In humans, isolated hormone deficiencies can affect hematopoiesis. Severe hypothyroidism can result in normocytic anemia.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Hormones and the Bone Marrow: Panhypopituitarism and Pancytopenia in a Man with a Pituitary Adenoma

2015

View full text Add to dashboard Cite

In rare cases, pancytopenia results from hormonal deficiencies that arise in the setting of panhypopituitarism. Here we describe the unusual case of a 60-year-old man who presented with progressive fatigue and polyuria, and whose laboratory workup revealed a deficiency of the five hormones associated with the action of the anterior pituitary (thyroid hormone, testosterone, cortisol, prolactin, and insulin-like growth factor-1). Imaging of the pituitary demonstrated a cystic mass consistent with a pituitary adenoma replacing much of the normal pituitary tissue. His symptoms and hematologic abnormalities rapidly resolved with prednisone and levothyroxine supplementati on. While the m ajority of r eported cases of panhypopituitarism with bone marrow suppression are the result of peripartum sepsis or hemorrhage leading to pituitary gland necrosis (Sheehan's syndrome), it is also important to consider the diagnosis of hypopituitarism in patients with hypothyroidism, low cortisol levels, and pancytopenia. The causal relationship between pancytopenia and panhypopituitarism is not well understood, though it does reinforce the important influence of these endocrine hormones on the health of the bone marrow. CASE PRESENTATIONA 60-year-old man was admitted to Massachusetts General Hospital with chest pain thought to be the result of his longstanding gastroesophageal reflux disease. He had a history of glaucoma, atypical nevi, and diverticulosis. He reported progressively worsening fatigue and weakness, a 10 lb weight loss, polyuria, and increased thirst. Laboratory testing on presentation was notable for hyponatremia (116 mmol/L) and pancytopenia. Out of concern for an underlying malignancy, the patient underwent contrast-enhanced computed tomography scans of the chest, abdomen, and pelvis, which were unremarkable. Given his progressive fatigue and hyponatremia, a morning serum cortisol level was checked and found to be very depressed (1.0 μg/dL; normal range 5-25 μg/dL). This prompted a more extensive endocrine evaluation (Table 1) that resulted in documentation of low levels of thyroid hormone, cortisol, testosterone, prolactin, and insulin-like growth factor-1 (IGF-1). A diagnosis of panhypopituitarism was made based on the reduced levels of all five hormones associated with the action of the anterior pituitary. A cosyntropin stimulation test demonstrated an inappropriately low increase in serum cortisol levels (1.2 to 7.4 μg/dL), suggesting reduced adrenal responsiveness due to prolonged adrenocorticotropic hormone (ACTH) deficiency. Though euvolemic, the patient displayed hyponatremia, with elevated urine osmolality, suggesting a component of elevated antidiuretic hormone (ADH) thought to be compensatory in the setting of glucocorticoid deficiency.In evaluation of the pituitary gland, MRI demonstrated a 6 mm cystic lesion in the posterior aspect of the pituitary (Fig. 1a). The radiologic appearance was most consistent with a cystic pituitary adenoma compressing and replacing the normal tissue of the pituitary gland. ...

show abstract

“…Dear Editor, I read with interest the case series and review of Sheehan's syndrome and pancytopenia by Laway et al [1]. The authors suggest that thyroid and cortisol hormones are ultimately responsible for the marrow hypoplasia.…”

mentioning

confidence: 99%

Pancytopenia secondary to hypopituitarism may just be due to hypothyroidism alone

Lee

2010

Ann Hematol

View full text Add to dashboard Cite

Sheehan’s syndrome with pancytopenia—complete recovery after hormone replacement (case series with review)

Cited by 29 publications

References 10 publications

Pancytopenia Associated with Hypopituitarism in an Acromegaly Patient: A Case Report and a Review of the Literature

Pancytopenia Associated with Hypopituitarism in an Acromegaly Patient: A Case Report and a Review of the Literature

Hormones and the Bone Marrow: Panhypopituitarism and Pancytopenia in a Man with a Pituitary Adenoma

Pancytopenia secondary to hypopituitarism may just be due to hypothyroidism alone

Contact Info

Product

Resources

About