Endocrine Abstracts

Sheehan’s syndrome represents a rare cause of pituitary insufficiency, produced by an ischemic pituitary necrosis due to a severe haemorrhage at deliverance. Epidemiologic data indicate that, nowadays, this disease is quite rare in developed country.

Aim: To determine and evaluate the clinical and hormonal characteristics of cases with Sheehan’s syndrome diagnosed and follow-up in our Clinic, during the last ten years.

Subjects and methods: We included, in this retrospective study, 13 patients, mean age 58±10.9 years, diagnosed with Sheehan’s syndrome. Data about medical history, routine laboratory determinations, hormonal parameters, pituitary imaging and therapy were reviewed. All the cases presented a history of severe uterine bleeding after last delivery.

Results: The age at diagnosis for these patients varied between 19 and 54 years. The period of follow-up from the moment of diagnosis was between 3 and 48 years. All except one of the cases had an assisted deliverance, but more than half of the cases (53.8%) came from rural area. Due to severe uterine bleeding, hysterectomy was performed in 7 patients (53.8%). In 12/13 subjects, breastfeeding was not possible. The diagnostic of Sheehan’s syndrome was established after 0.5 to 28 years from pathological deliverance. The longest delay between the moment of delivery and those of diagnostic was 28 years. All the cases presented corticotropin, thyreotropin and gonadotropins deficiency in the moment of diagnosis. Growth hormone deficiency was documented in 2 patients and one subject was diagnosed with central diabetes insipidus. Hormonal substitution therapy with thyroxine and glucocorticoids was used in all the cases. Gonadotropins deficiency was treated with estroprogestative in younger subjects and GH replacement treatment was given in two cases. Desmopressin was given in one patient for ADH deficiency.

Conclusion: Sheehan’s syndrome is still present in clinical practice, even in the condition of assisted deliverance and well-managed uterine haemorrhage.