Sheehan’s syndrome: case report

Síndrome de sheehan’s: relato de caso

Keywords: hypopituitarism, pituitary insufficiency, postpartum hemorrhage

Abstract

Sheehan’s Syndrome (SS) results from severe postpartum hemorrhage, causing pituitary necrosis and hormone deficiencies. While usually chronic, acute SS is rare and requires immediate management. Symptoms like hypotension, tachycardia, hyponatremia, and hypoglycemia suggest acute SS. A case involved a 32-year-old woman with severe hypotension and tachycardia postpartum, diagnosed with SS based on MRI findings. Acute SS stems from anterior pituitary infarction due to reduced blood flow, often following childbirth. Risk factors include multiparity and induced labor. Diagnosis relies on history, symptoms, and imaging. Acute cases may lead to circulatory collapse. Treatment involves hormone replacement therapy, with levothyroxine for thyroid dysfunction and estrogen-progesterone for gonadotropin deficiency. GH replacement is debated. Early diagnosis and therapy are vital to improve outcomes. This case underscores the importance of initiating levothyroxine and outpatient monitoring for SS. Increasing awareness is crucial for timely intervention, enhancing patients' quality of life and reducing morbidity and mortality.

References

Laway BA, Baba MS. Sheehan syndrome: Cardiovascular and metabolic comorbidities. Front Endocrinol [Internet]. 2023 Jan [cited 10 apr 2024]; 14. Available from: https://doi.org/10.3389/fendo.2023.1086731

Matsuzaki S, Endo M, Ueda Y, Mimura K, Kakigano A, Egawa-Takata T, et al. A case of acute Sheehan’s syndrome and literature review: a rare but life-threatening complication of postpartum hemorrhage. BMC Pregnancy Childbirth [Internet]. 14 jun 2017 [cited 10 apr 2024];17(1). Available from: https://doi.org/10.1186/s12884-017-1380-y

Schury MP, Adigun R. Sheehan Syndrome. [Updated 2022 Sep 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459166/

Hale B, Habib AS. Sheehan syndrome: acute presentation with severe headache. Int J Obstet Anesthesia [Internet]. Nov 2024 [cited 10 apr 2024];23(4):383–6. Available from: https://doi.org/10.1016/j.ijoa.2014.04.011

Sheehan HL. Post-partum necrosis of anterior pituitary. J Pathol Bacteriol [Internet]. Jul 1937 [cited 10 apr 2024]; 45(1): 189-214. Available from: https://doi.org/10.1002/path.1700450118.

Kovacs K. Sheehan syndrome. Lancet [Internet]. Fev 2023 [cited 10 apr 2024];361(9356):520-2.Available from: https://doi.org/10.1016/s0140-6736(03)12490-7.

Diri H, Karaca Z, Tanriverdi F, Unluhizarci K, Kelestimur F. Sheehan’s syndrome: new insights into an old disease. Endocrine [Internet]. 1 sep 2015 [cited 10 apr 2024]; 51(1):22–31. Available from: https://doi.org/10.1007/s12020-015-0726-3

Karaca Z, Laway BA, Dokmetas HS, Atmaca H, Kelestimur F. Sheehan syndrome. Nat Rev Dis Primers [Internet]. 22 dec 2016 [cited 10 apr 2024]: 2(1). Available from: https://doi.org/10.1038/nrdp.2016.92.

Tabares GG, Gutiérrez K. Sheehan's syndrome: Epidemiology, clinical features, diagnosis and treatment. Rev Columb Menospaus [Internet]. 2019 [cited 10 apr 2024]; 25(3): 25-32. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/biblio-1283732.

Bakiri F, Bendib SE, Maoui R, Bendib A, Benmiloud M. The sella turcica in Sheehan's syndrome: computerized tomographic study in 54 patients. J Endocrinol Investig [Internet]. Mar 1991 [cited 10 apr 2024]; 14(3):193-6. Available from: https://doi.org/10.1007/bf03346787.

Leal RM, De Oliveira FT, Dantas RS, Leite MC, Cruz ARC, Oliveira HS, Bomfim NSC, Nascimento BV. Síndrome de Sheehan, um relato de caso. Braz J Dev [Internet]. 2 mar 2023 [cited 10 apr 2024]; 9(3):9314–23. Available from: https://doi.org/10.34117/bjdv9n3-031.

Soares DV, Conceição FL, Vaisman M. Aspectos diagnósticos e terapêuticos da síndrome de Sheehan. Arq Bras Endocrinol Amp Metabol [Internet]. Jul 2008 [cited 10 apr 2024]; 52(5):872-8. Available from: https://doi.org/10.1590/S0004-27302008000500020.

Dourado ML, Costa TP, Carvalho MS, Moura CG. Reversibilidade da Cardiomiopatia Dilatada na Síndrome de Sheehan: Um Relato de Caso. Arq Bras Cardiol [Internet]. Fev 2021 [cited 10 apr 2024];116(2 suppl 1):17-20. Available from: https://doi.org/10.36660/abc.20190547.

Matsuzaki S, Endo M, Ueda Y, Mimura K, Kakigano A, Egawa-Takata T, et al. A case of acute Sheehan’s syndrome and literature review: a rare but life-threatening complication of postpartum hemorrhage. BMC Pregnancy and Childbirth [Internet]. 14 jun 2017 [cited 10 apr 2014];17 (1). Available from: https://doi.org/10.1186/s12884-017-1380-y.

Soares DV, Conceição FL, Vaisman M. Aspectos diagnósticos e terapêuticos da síndrome de Sheehan. Arq Bras Endocrinol Amp Metabol [Internet]. Jul 2008 [cited 10 apr 2024]; 52(5):872-8. Available from: https://doi.org/10.1590/s0004-27302008000500020.

Baggio MA, Contiero AP, Schapko TR. Obstetric practices and childbirth care: a mixed method study. Saud Pesq [Internet]. Mar 2024 [cited 10 apr 2024];17(1) . Available from: https://doi.org/10.17765/2176-9206.2024v17n1.e12057.

Published
2024-08-25
Section
Relato de Casos