International Journal of Health and Clinical Research
Yazarlar: Swet Nisha, Kalpana Singh, Shubhanti Kumari
Konular:-
Anahtar Kelimeler:PPH,Sheehan’s syndrome,Secondary amenorrhoea,Lactation failure.
Özet: Introduction: Sheehan’s syndrome is defined by varying degrees of anterior pituitary hormones deficiency due to postpartum ischemia of the pituitary gland after massive postpartum haemorrhage and shock. It can present during postpartum or several months or years following delivery. Endocrinologic manifestations of hypopituitarism reveal the deficiencies of specific hormones secreted from pituitary gland including hypoadrenalism, hypothyroidism and hypogonadism.Aims and Objectives:To highlight the under diagnosed cases of Sheehan’s syndrome. Materials and Methods: A retrospective analysis of Sheehan’s syndrome was done over a period of 3 months from June 2019 to August 2019, at Reproductive Medicine department, IGIMS, Patna, Bihar, India; after clearance from institutional ethics committee. Case from 2010 to 2019 were taken. All the patients attending Reproductive Medicine OPD, Endocrinology OPD or presenting in Emergency with acute episodes of diarrhoea & vomiting and not maintaining BP, at IGIMS, Patna, were included. Se FSH, Se LH, Se Estradiol, Se Thyroid profile, Se Cortisol and ACTH stimulated cortisol along with CT Scan were done.We aimed to highlight the under diagnosed cases of Sheehan’s syndrome (≥2 hormonal axis impairment).Result: A retrospective analysis was done. Total 15 cases were diagnosed. The mean age of presentation was 38.315.9 years.Year of presentation following last delivery was 4-16 years. Mean duration was 7.67 3.76 years. Secondary amenorrhea and lactation failure were the most common clinical presentations. 11 patients presented with failure to resume menses following delivery and 3 had oligomenorrhea following secondary amenorrhea. 12 patients presented with lactation failure. All the 15 patients had history of severe PPH and 10 had home deliveries.The mean total tetraiodothyronine (T4), peak stimulated cortisol, stimulated growth hormone (GH), and prolactin (PRL) levels were low. Even in the presence of amenorrhoea the gonadotropins [follicle stimulating hormone (FSH) and luteinizing hormone (LH)] were inappropriately normal. Estrogen levels were low in 14 patients(93.33%). The most common hematological abnormality seen was anemia (53.33%) in 8 patients, while 5 patients (33.33%) had hyponatermia. 9 patients(60%) had empty sella turcica while 6 patients (40%) were having normal CT scan. BMD assessment (n = 15) was suggestive of low bone mass. After one year of hormonal replacement therapy, the QoL improved significantly (P < 0.05). Conclusion: Sheehan’s syndrome is a frequent cause of hypopituitarism in developing countries and usually present with Subtle clinical features. It causes multiple pituitary hormone deficiencies in all patients. It is prone to be missed and delayed diagnosis is common.Severe PPH, failure to lactate and cessation of menses are important clues. In patients with Sheehan’s syndrome anemia, hyponatremia, and low bone mass were frequently seen. It is eminently treatable with gratifying response. The QoL improved significantly (P < 0.05) after one year of hormonal replacement therapy. With improved obstetric care we canprevent it.