Sheehan

Neuroendocrinology Letters No.3 June Vol.26, 2005 Copyright © 2005 Neuroendocrinology Letters ISSN 0172–780X www.nel.edu

Sheehan Syndrome: Clinical and laboratory evaluation of 20 cases*
Yusuf Özkan & Ramis Colak
Firat University School of Medicine, Department of Endocrinology and Metabolism, Elazig, Turkey. Correspondence to: Dr. Yusuf ÖZKAN Firat University School of Medicine, FiratMedical Center, Department of Endocrinology and Metabolism, 23119-Elazığ, TURKEY TEL : +90 424 2333555/1662, FAX : +90 424 2330038 EMAIL : dryusufozkan@hotmail.com Accepted: February 3, 2005

CASE

Submitted: October 15, 2004
Key words:

Sheehan syndrome; pituitary insufficiency; empty sella
NEL260305A11 © Neuroendocrinology Letters www.nel.edu

Neuroendocrinol Lett 2005; 26(3):257–260 PMID:15990732

REPORT

Abstract

Sheehan syndrome (SS) or post-partum pituitary necrosis is a pituitary insufficiency secondary to excessive post-partum blood losses. SS is a very significant cause of maternal morbidity and mortality in developing countries although it is a rarity in developed countries in which obstetrical care has been improved. In this study, we reviewed 20 cases retrospectively whowere diagnosed as SS in our clinic. The patients aged 40 to 65 years with a mean age of 51.12 ± 9.44 years (mean ± SD). Time to make a definitive diagnosis of the disease ranged between 5 and 25 years with a mean of 16.35 ± 4.74 years. Three of our patient (15%) had a previous diagnosis of SS. Three patients (15%) were referred to emergency service for hypoglycemia, three patients (15%) forhypothyroidism and one patient (5%) for hyponatremia. Dynamic examination of the pituitary revealed GH, Prolactin, FSH, TSH and ACTH insufficiency in all of the patients. One of our patients had a sufficient LH response to LHRH challenge. All of the patients were imaged with pituitary MRI. Eleven patients had empty sella and 9 patients had partial empty sella. SS is still a common problem in our country,especially in rural areas. Considering the duration of disease, important delays occur in diagnosis and treatment of the disease. *This study was presentecd as a poster at the 3rd Regional International Society of Psychoneuroendocrinology (ISPNE) Congress for Central & Eastern Europe. Nevsehir / Cappadocia / Turkey, May 13–15, 2004.

Introduction
Sheehan syndrome (SS) or post-partum pituitarynecrosis is an adeno-pituitary insufficiency from hypovolemia secondary to excessive blood losses during of after the delivery. It was first described by Sheehan in 1937. Sheehan’s studies based on autopsy findings of the patients died of uterine bleeding immediately after the delivery and hypopituitarism findings in the patients who survived despite massive bleeding during the delivery [1]. Althoughthe pathogenesis of SS is not clear, it is clear that the basic event is infarct in the ante-

Yusuf Özkan & Ramis Colak

rior pituitary due to decreased blood volume [2]. It is not clear whether this infarct is due to vasospasm, thrombosis or a vascular compression. Pituitary volume increases two fold during pregnancy. This is due to hyperplasia of prolactin secreting cells from elevatedestrogen secretion. Enlarged pituitary gland may be compressing the blood vessels supporting it or there may be a predisposition in pregnant women compared with non-pregnant women or these two conditions may concur [2]. Pituitary gland doesn’t have ability to regenerate. Scar tissue substitutes the necrotic cells. Presence of 50% of pituitary gland suffices for maintenance of normal functions [2].Partial or total hypopituitarism develops with necrosis of 70 to 90% of the gland. It is believed that 32% of women with severe post-partum bleeding develop hypopituitarism [3]. SS is a very significant cause of maternal morbidity and mortality in developing countries although it is a rarity in developed countries in which obstetrical care has been improved. It is prevalent especially in eastern...