Four decades without diagnosis: Sheehan‘s syndrome, a retrospective analysis

Abstract

Aim: Sheehan‘s syndrome (SS) remains a frequent cause of hypopituitarism in undeveloped and developing countries, but due to improvements in obstetric care, it is rare in developed countries. We aimed to share the results of a retrospective study analyzing the demographic, clinical, imaging, and hormonal characteristics of a large group of patients with SS, and also increase awareness of this syndrome especially in developed countries.

Methods: The medical records of 124 patients with SS patients who were followed up in the Endocrinology Department of Dicle University between 1995 and 2015 were assessed retrospectively.

Results: The mean period of diagnostic delay was 20.37 ± 8.34 years on average. 5.7% of patients with SS were literate; 62% of patients delivered at home. Anemia was identified in 64.5% of SS patients. Mean blood sodium levels were 129.8 ± 11.3 mEq/L. The mean urine densities were 1013 ± 6.5. Osteoporosis and osteopenia were found in 44 (35.4%) and 71 (57.2%) patients, respectively, According to pituitary magnetic resonance imaging (MRI) analyses, 92 (74.2%) patients with SS had completely empty sella, 29 (23.3%) had partially empty sella, and 1 patient had microadenoma, and 2 had normal pituitary MRI results.

Conclusions: Improved obstetric care and effective interventions for postpartum hemorrhage have limited the prevalence of SS in developed countries. However, in developing countries like Turkey, SS due to postpartum bleeding remains common. Thus, physician’s awareness of the symptoms of SS is urgently required to avoid the associated morbidity and mortality.

Chinese abstract

目的: 席汉综合征 (Sheehan‘s , SS) 目前仍然是不发达国家和发展中国家垂体功能减退的常见原因, 而由于产科护理的改善, 它在发达国家中是罕见的。我们的目的是分享一项回顾性研究的结果, 此研究对大量患有SS的患者就人口统计学、临床、影像学, 和激素的特点进行了分析, 同时也能增加大众对该综合征的认识, 特别是在发达国家。

方法: Dicle大学内分泌系对124名SS患者进行随访, 随访期从1995年至2015年, 并对得到的病历结果做回顾性评估。

结果: 平均诊断延迟期为 20.37 ± 8.34年。其中5.7%的患者有文化；62%的患者在家里。64.5%的患者确诊有贫血。平均血钠水平为129.8 ± 11.3 mEq/L。平均尿密度为1013 ± 6.5。发现44 (35.4%) 例骨质疏松症和71 (57.2%) 例骨量减少, 根据垂体磁共振成像 (MRI) 分析, SS患者中有92 (74.2%) 例已经完全空蝶鞍, 29 (23.3%) 例有部分空蝶鞍, 1例垂体微腺瘤, 2例为正常垂体的MRI结果。

结论: 在发达国家, 改善的产科护理和有效的产后出血干预措施, 限制了SS的患病率。然而, 在发展中国家, 如土耳其, 由产后出血导致的SS却仍然常见。因此, 迫切需要提高医生对SS症状的意识, 以避免相关的发病率和死亡率。

Keywords:

• Hypothalamic amenorrhea
• osteoporosis
• pituitary gland

Declaration of interest

Though this is an unsponsored research, the authors declare that no financial funding was received.