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Sheehan's Syndrome with Edema in Optical Neural Sheaths: A Case Report

Year 2013, Volume: 38 Issue: 2, 299 - 304, 01.06.2013

Abstract

Sheehan syndrome is partial or complete hypophyseal insufficiency due to hypophyseal necrosis secondary to postpartum hemorrhage and hypovolemia. Clinical findings are cessation of lactation, secondary amenorrhea, loss of libido and hypophyseal reserve loss. Treatment is hormone replacement. Forty-four years old women admitted with somnolence, malaise, edema and blurred vision. Physical examination revealed edema and hypotension. She had massive bleeding during her birth 11 years old ago; therefore she had received blood transfusion and could not breast-feed then. She had amenorrhea when she admitted. She was diagnosed to be Sheehan syndrome while glucocorticoid and levothyroxine replacement was started. Hypophyseal and orbital magnetic resonance imaging revealed empty sella and edema in bilateral optical neural sheaths respectively. Empty sella may cause edema in optical neural sheaths by increasing pressure in subarachnoidal space. We present this case to point out this coincidence.

References

  • Sheehan HL. Postpartum necrosis of the anterior pituitary. J Pathol bacterial. 1937;45:189-214.
  • Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC. İn: Williams Obstetrics 20 st ed. NewYork: Appleton and Lange. 1997;763.
  • Kelestimur F. Sheehan’s Syndrome. Pituitary. 2003; 6:181–8.
  • Kovacs K. Sheehan syndrome. Lancet. 2003; 361:520–2.
  • Koşuş A, Koşuş N, Çapar M. Yavaş gelişen Sheehan sendromu ve empty sella: Postpartum kanamanın nadir bir komplikasyonu. Fırat Tıp Dergisi. 2009;14:93-6.
  • Veldhuis JD, Hammond JM. Endocrine function after spontaneous infarction of the human pituitary: report, review, and reappraisal. Endocr Rev. 1980;1:100-7.
  • JK Agarwal, RK Sahay, SK Bhadada, Vijay Sekhar Reddy, NK Agarwal. Empty Sella Syndrome. Journal Indian Academy of Clinical Medicine. 2001;2:19820
  • Huang YY, Ting MK, Hsu BR, Tsai JS. Demonstration of reserved anterior pituitary function among patients with amenorrhea after postpartum hemorrhage. Gynecol Endocrinol. 2000;14: 99-104.
  • Boulanger E, Pagniez D, Roueff S, Binaut R, Valat AS, Provost N, et al. Sheehan syndrome presenting as early post-partum hyponatraemia. Nephrol Dial Transplant. 1999;14: 2714-5.
  • Lavalle´e G, Morcos R, Palardy J, Aube´ M, Gilbert D. MR of Nonhemorrhagic Postpartum Pituitary Apoplexy. Am J Neuroradiol. 1995;16:1939-41.
  • Bonneville JF, Dietmann JL. Intrasellar pathology. In: Radiology of the Sella turcica. Springer Verlag, New York. 1981;89-126.
  • Kaufman B. The “empty” sella turcica, a manifestation of the intrasellar subarachnoid space. Radiology. 1968;90:931-46.
  • Bates AS, Von’t Hoff W, Jones PJ, Clayton RN. The effects of hypopituitarism on life expectancy. J Clin Endocrinol Metab.1996;81:110– 14.
  • Sert M, Tetiker T, Kirim S, Kocak M. Clinical report of 28 patients with Sheehan's syndrome. Endocr J. 2003; 50:297-301.
  • Yazışma Adresi / Address for Correspondence: Dr. Mehtap Evran Çukurova Üniversitesi Tıp Fakültesi, İç Hastalıkları Anabilim Dalı 01330 Balcalı-ADANA e-mail: mehtap.evran@hotmail.com geliş tarihi/received :24.09.2012 kabul tarihi/accepted:07.12.2012

Optik Sinir Kılıflarında Ödem Saptanan Bir Sheehan Sendromu Olgusu

Year 2013, Volume: 38 Issue: 2, 299 - 304, 01.06.2013

Abstract

Sheehan sendromu postpartum kanama ve hipovolemiye sekonder olarak ortaya çıkan hipofiz nekrozuna bağlı parsiyel veya tam hipofiz yetmezliğidir. Klinik bulgular laktasyonun kesilmesi, sekonder amenore, libido kaybı ve hipofiz rezerv kaybı ile ilişkili bulgular ile karakterizedir. Tedavide hormon replasmanı kullanılır. 44 yaşındaki kadın sürekli uyuma isteği, halsizlik, vücutta şişlik ve görme bulanıklığı yakınması ile kliniğe kabul edildi. Fizik muayenede hipotansiyon ve ödem saptandı. Özgeçmişinde 11 yıl önce doğum yaptığı, aşırı kanamasının olduğu, kan transfüzyonu yapıldığı ve sonrasında bebeğini emziremediği bildirildi. Hali hazırda amenoresi olduğu belirlendi. Sheehan sendromu olarak değerlendirilen olguya glukokortikoid ve levotiroksin replasmanı başlandı. Hipofiz magnetic rezonans görüntülemede empty sella, orbital magnetik rezonans görüntülemede ise bilateral optik sinir kılıflarında ödem saptandı. Empty sella subaraknoid mesafede basınç artışına yol açarak optik sinir kılıfında ödeme neden olabilir. Bu olgu nedeniyle klinik pratiğimizde ender görülen bu birlikteliğe dikkat çekilmek istenmiştir.

References

  • Sheehan HL. Postpartum necrosis of the anterior pituitary. J Pathol bacterial. 1937;45:189-214.
  • Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC. İn: Williams Obstetrics 20 st ed. NewYork: Appleton and Lange. 1997;763.
  • Kelestimur F. Sheehan’s Syndrome. Pituitary. 2003; 6:181–8.
  • Kovacs K. Sheehan syndrome. Lancet. 2003; 361:520–2.
  • Koşuş A, Koşuş N, Çapar M. Yavaş gelişen Sheehan sendromu ve empty sella: Postpartum kanamanın nadir bir komplikasyonu. Fırat Tıp Dergisi. 2009;14:93-6.
  • Veldhuis JD, Hammond JM. Endocrine function after spontaneous infarction of the human pituitary: report, review, and reappraisal. Endocr Rev. 1980;1:100-7.
  • JK Agarwal, RK Sahay, SK Bhadada, Vijay Sekhar Reddy, NK Agarwal. Empty Sella Syndrome. Journal Indian Academy of Clinical Medicine. 2001;2:19820
  • Huang YY, Ting MK, Hsu BR, Tsai JS. Demonstration of reserved anterior pituitary function among patients with amenorrhea after postpartum hemorrhage. Gynecol Endocrinol. 2000;14: 99-104.
  • Boulanger E, Pagniez D, Roueff S, Binaut R, Valat AS, Provost N, et al. Sheehan syndrome presenting as early post-partum hyponatraemia. Nephrol Dial Transplant. 1999;14: 2714-5.
  • Lavalle´e G, Morcos R, Palardy J, Aube´ M, Gilbert D. MR of Nonhemorrhagic Postpartum Pituitary Apoplexy. Am J Neuroradiol. 1995;16:1939-41.
  • Bonneville JF, Dietmann JL. Intrasellar pathology. In: Radiology of the Sella turcica. Springer Verlag, New York. 1981;89-126.
  • Kaufman B. The “empty” sella turcica, a manifestation of the intrasellar subarachnoid space. Radiology. 1968;90:931-46.
  • Bates AS, Von’t Hoff W, Jones PJ, Clayton RN. The effects of hypopituitarism on life expectancy. J Clin Endocrinol Metab.1996;81:110– 14.
  • Sert M, Tetiker T, Kirim S, Kocak M. Clinical report of 28 patients with Sheehan's syndrome. Endocr J. 2003; 50:297-301.
  • Yazışma Adresi / Address for Correspondence: Dr. Mehtap Evran Çukurova Üniversitesi Tıp Fakültesi, İç Hastalıkları Anabilim Dalı 01330 Balcalı-ADANA e-mail: mehtap.evran@hotmail.com geliş tarihi/received :24.09.2012 kabul tarihi/accepted:07.12.2012
There are 15 citations in total.

Details

Primary Language Turkish
Journal Section Research
Authors

Mehtap Evran This is me

Hüseyin Tuğsan Ballı This is me

Publication Date June 1, 2013
Published in Issue Year 2013 Volume: 38 Issue: 2

Cite

MLA Evran, Mehtap and Hüseyin Tuğsan Ballı. “Optik Sinir Kılıflarında Ödem Saptanan Bir Sheehan Sendromu Olgusu”. Cukurova Medical Journal, vol. 38, no. 2, 2013, pp. 299-04.