Endocrine Abstracts (2006) 11 P199

Clinical evaluation of sheehan syndrome

A Kubat Uzum, M Mert, Y Orhan, N Ozbey & F Aral

Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey.

The term Sheehan syndrome refers to the development of pituitary necrosis due to ischemia within a few hours of delivery. Usually, antecedent hypotension and shock are present, resulting most commonly from obstetric hemorrhage. In such instances evidence of adrenal and thyroid insufficiency should be sought. A classical symptom of Sheehan’s syndrome is the absence of lactation after delivery related to prolactin deficiency. We retrospectively analysed 64 patients who were diagnosed as Sheehan syndrome in Istanbul Faculty of Medicine, Endocrinology and Metabolism Clinic, in 1980–2005.

Mean ages at delivery and diagnosis were 29.14±5.66 (16–40) and 39.69±8.21 (24–60), respectively. Unfortunately, diagnose was delayed 9.92±7.78 years. All patients had a history of massive and elonged hemorrhage period at delivery. Six of them were twin pregnancies, and eight of them lasted by fetal death. Fourty-nine (% 76.6) patients neither menstruate nor lactate any more. The clinical presentations were as acute form of Sheehan’ syndrome in 14 patients (% 21.9). One patient was diagnosed after generalized tonic-clonic convulsion induced by hypoglysemia. Twenty-three patients had low serum glucose concentrations (minimum 16 mg/dl). Eight patients had hyponatremia (minimum sodium concentration was 118 mEq/L). All patients (100%) had hypogonadism. Sixty patients (93.75%) had primary, four patients (6.25%) had secondary hypothyroidism. Fifty six (87.5%) patients were hypocortisolemic. We performed corticotropin stimulation test with 250 μg ACTH for patients who were diagnosed ≥ 5 years after delivery. Ten patients had adrenal insufficiency, too. None of the patients had diabetes insipidus.

Total cholesterol, LDL-cholesterol, VLDL-cholesterol and trigliseride levels had positive correlation with years passed for diagnose (P<0.001).

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