Background: Postpartum hypopituitarism, known as Sheehans syndrome, occurs during a complicated childbirth, due to severe hemorrhage and hpovolemic shock that lead to ischemic necrosis of the pituitary gland.
The aim of the study is to point out the clinical features in postpartum pituitary necrosis, so that the disease could be recognize rapidly, to present a laboratory work-up for a postive diagnosis, and also to describe the complications of the untreated cases.: Material and method
The study included 19 patients, admitted to the Clinic of Endocrinology, Timisoara, Romania, in the period 20082013. The mean age at diagnosis was 48.8±8.2 years.: Results
After a difficult childbirth with massive hemorrhage, 36.8% of patients were diagnosed during the first weeks with postpartum pituitary necrosis, due to agalactia and amenorrhea. The rest of the patients were diagnosed after few years (mean duration until positive diagnosis: 36.2±13.9 months). All women presented at diagnosis an unspecific clinical picture with asthenia, hypotension, palor, secondary amenorrhea, sparse axillary and pubic hair, and hypoglycemia. A percent of 31.5% suffered an emergency histerectomy.: The hormonal determinations confirmed in all patients the central hypogonadism and low levels of prolactin. A percent of 73.6% presented secondary hypothyroidism, 89.4% central adrenal insufficiency, respectively 57.8% GH deficiency. In none of the cases was diagnosed central diabetes insipidus. Four patients presented mild hyponatremia at diagnosis. Pituitary magnetic resonance imaging confirmed empty sella in ten women.
Conclusion: The recognition of the signs and symptoms of postpartum pituitary necrosis is mandatory for an early diagnosis and treatment, the mortality and morbidity of the untreated disease being significant.