A Case of Pulmonary Thromboendarterectomy

Abstract

Fourtyfive years old patient with parity 1 was admitted hospital due to amenorrhea. She had given birth at home 20 years ago and had severe bleeding due to retained placenta. Her hormonal examination showed panhypopitiutarism. Empty sella was diagnosed by MRI examination. Glucocorticoid, thyroxin and estrogen-progesteron treatment were given. Sheehan's Syndrome is insufficiency of pituitary and adrenal gland due to postpartum hemorrhage and hypovolemia. Symptoms may develop immediately or after years depending on severity of pituitary destruction. Most prominant symptoms are secondary amenorrhea, loss of lactation, loss of libido and other symptoms due to loss of pituitary reserves. Empty sella is complete or incomplete insufficiancy of hypophysis due to intracellar herniation of subarachnoid structures. One cause of empty sella is pituitary necrosis developing after severe postpartum hemorrhage (Sheehan's Syndrome). CT and MRI are best methods for diagnosis of empty sella. Hormon replacement treatment (glucocorticoid, thyroxin and estrogen-progesteron) is given to patients with Sheehan's Syndrome.

Keywords

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Yavaş Gelişen Sheehan Sendromu ve Empty Sella: Postpartum Kanamanın Nadir Bir Komplikasyonu

Öz

45 yaşındaki 1 çocuklu hasta adet görememe şikayetiyle kliniğimize başvurdu. Hastanın özgeçmişinde 20 yıl önce evde doğum yaptığı, doğum sonrası plasentanın düşmemesi nedeniyle aşırı kanamasının olduğu öğrenildi. Hastanın yapılan hormon tahlillerinde panhipopituitarizm bulguları görüldü. MRI incelemesinde hastada empty sella tesbit edildi. Glukokortikoid, tiroksin ve estrojen - progesteron tedavisi başlandı. Sheehan Sendromu postpartum kanama ve hipovolemiye bağlı olarak gelişen hipofiz ve adrenal yetmezliğidir. Hipofizin hasar derecesine göre belirtiler hemen ya da yıllar sonra ortaya çıkabilir. En belirgin özellikler laktasyonun kesilmesi, sekonder amenore, libido kaybı ve hipofiz rezervlerinin kaybına bağlı gelişecek semptomlardır. Empty sella, suprasellar subaraknoid yapıların intrasellar herniasyonu sonucu meydana gelen komplet ya da inkomplet hipofiz yetmezliğidir. Empty sella sendromunun nedenlerinden biri aşırı postpartum kanama sonucu gelişen hipofiz nekrozudur (Sheehan Sendromu). CT ve MRI empty sellanın tanısında en önemli teşhis metodlarıdır. Sheehan Sendromu gelişen hastalarda hormon replasman (glukokortikoid, tiroksin ve östrojen/progesteron) tedavisi uygulanır.

Anahtar Kelimeler

• Sheehan Sendromu, Hipopituitarizm, Empty Sella Sendromu

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29. Kabul Tarihi: 09.05.2008