Endocrine Abstracts (2011) 26 P170

Metabolic encephalopathy and quadriparesis induced by severe hyponatremia in the patient with Sy Seehan

Jelena Bogdanovic1, Radmila Stojanovic Perusko1, Dragana Popovic1, Radojka Dzomlija1, Vera popovic1, Marko Ercegovac2, Ljiljana Bogdanovic3 & Dusan Micic1

1Clinic for Endocrinology, Diabetes and Metabolic Diseases, Belgrade, Serbia; 2Clinic for Neurology, Clinical Center of Serbia, Belgrade, Serbia; 3Institute for Pathology, Belgrade, Serbia.

Sy Sheehan or postpartal pituitary necrosis presents with symptoms and signs of hypopituitarisms. It is usually a consequence of complicate delivery followed by intensive uterine bleeding. Diagnosis can be delayed years after delivery, up to 20 years.

We present a case of 51-year-old female patient. She was admitted in the department of neurology in the Emergency center, Belgrade, with disturbance of consciousness. Few days before she felt leg weakness and numbness, become sleepness and develop disturbance of consciousness. There was no serious illness in the previous history. She born four children, the last delivery was 10 years ago and it was complicated with prolonged bleeding. After that there was no lactation or restoring of menstrual cycles, body hear disappeared in the following years.

In the moment of administration patient was somnolent, dehydrated, body hear were absent, breasts atrophic, TA 100/80 mmHg. Neurologic status showed quadriparesis. EEG was performed showing diffuse encephalopathic changes with irritative focal locus on the left side. NMR of endocranium revealed empty sella with thickening of stalk. Laboratory analyses showed severe hyponatremia 116 mmol/l, normocytic anemia Hb 85, RBC 2.83, MCV 88. Other routine analises were without changes.

We made a diagnosis of hypopituitarismus and patient was tranfered to Metabolic unit of EC. Hormone analyses confirmed diagnosis: FT4 <5.1, TSH 0.22, cortisol/0800 h/344.2, ACTH 17.2, IGF1 30.2, FSH 11.6, LH 1.8, LTH/pulled blood/308, estradiol 36.9, insulin 30.2.

Therapy was started with administration of isotonic saline solutions and substitution with hydrocortison, several days later L-thyroxine was added. After few days patient felt much better, electrolyte disorders was corrected and she was able to walk 3 weeks later. After 2 months on the control, hormonal analyses were corrected.

We present a patient with Sy Sheehan and severe hyponatremia that leads to metabolic encephalopathy and quadriparesis. Substitution treatment with Hydrocortison and L-thyroxine diminished all signs of illness.

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