A case of acute Sheehan’s syndrome and literature review: a rare but life-threatening complication of postpartum hemorrhage

BMC Pregnancy and Childbirth

Case Report

Aiko Kakigano¹  Tomomi Egawa-Takata¹  Kazuya Mimura¹  Tadashi Kimura¹  Shinya Matsuzaki¹  Keiichi Kumasawa¹  Kiyoshi Yoshino¹  Yutaka Ueda¹  Masayuki Endo¹ 

[1] Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan;

关键词: Hyponatremia;    Hypopituitarism;    Postpartum hemorrhage;    Sheehan syndrome;    Sheehan’s syndrome;    Subsequent pregnancy;   

DOI  :  10.1186/s12884-017-1380-y

 received in 2015-09-16, accepted in 2017-06-09,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundSheehan’s syndrome occurs because of severe postpartum hemorrhage causing ischemic pituitary necrosis. Sheehan’s syndrome is a well-known condition that is generally diagnosed several years postpartum. However, acute Sheehan’s syndrome is rare, and clinicians have little exposure to it. It can be life-threatening. There have been no reviews of acute Sheehan’s syndrome and no reports of successful pregnancies after acute Sheehan’s syndrome. We present such a case, and to understand this rare condition, we have reviewed and discussed the literature pertaining to it. An electronic search for acute Sheehan’s syndrome in the literature from January 1990 and May 2014 was performed.Case presentationA 27-year-old woman had massive postpartum hemorrhage (approximately 5000 mL) at her first delivery due to atonic bleeding. She was transfused and treated with uterine embolization, which successfully stopped the bleeding. The postpartum period was uncomplicated through day 7 following the hemorrhage. However, on day 8, the patient had sudden onset of seizures and subsequently became comatose. Laboratory results revealed hypothyroidism, hypoglycemia, hypoprolactinemia, and adrenal insufficiency. Thus, the patient was diagnosed with acute Sheehan’s syndrome. Following treatment with thyroxine and hydrocortisone, her condition improved, and she was discharged on day 24.Her next pregnancy was established 2 years after her first delivery. She required induction of ovulation for the next conception. The pregnancy, delivery, and postpartum period were uneventful. An electronic search of the literature yielded 21 cases of acute Sheehan’s syndrome. Presenting signs varied, including adrenal insufficiency (12 cases), diabetes insipidus (4 cases), hypothyroidism (2 cases), and panhypopituitarism (3 cases), with a median time of presentation after delivery for each of those conditions being 7.9, 4, 18, and 9 days, respectively. Serial changes in magnetic resonance imaging were reported in some cases of acute Sheehan’s syndrome.ConclusionClinicians should be aware of the risk of acute Sheehan’s syndrome after a massive postpartum hemorrhage in order to diagnose it accurately and treat it promptly.

【 授权许可】

CC BY   
© The Author(s). 2017