Endocrine Abstracts

Introduction: Sheehan’s syndrome (SS) is defined as partial or complete hypopituitarism occurring due to massive postpartum uterine hemorrhage that leads to pituitary infarction. Patients with SS have varying degrees of anterior pituitary hormone deficiency. The aim of our study was to evaluate the clinical and hormonal characteristics of patients with SS.

Methods: Eighteen patients with SS were enrolled in a retrospective and descriptive study. Medical history, physical examination findings and hormonal profiles were documented and analyzed.

Results: The mean age of participants at diagnosis was 41.76±11.31 years, with a mean diagnostic delay of 8.8±8.01 years. Their past obstetric history showed that the mean number of pregnancies was 5.43±2.57, that of deliveries was 4.56±2.41 and miscarriages was 1.24±1.5. Eleven of our patients (13.57%) had a home birth. Seventy-six patients (95%) reported amenorrhea starting immediately after delivery, while four (5%) patients had regular menses after the last delivery. In addition, 67 (83.8%) patients had postpartum agalactia. Overall hormonal assessment at the date of diagnosis revealed that all of the patients had hypogonadotropic hypogonadism and adrenal insufficiency, while 79 (98.8%) patients had secondary hypothyroidism and 72 (90%) patients had prolactin deficiency. Diabetes insipidus has not been found in any patient. Somatropic function was investigated in only 7 patients and was deficient in all of them. Twenty-five patients had pituitary MRI and ten patients had pituitary CT reports. According to CT and MRI findings, 30 patients with SS had a completely empty sella, while five patients had a partially empty sella.

Conclusion: Sheehan’s syndrome is a frequent cause of hypopituitarism in underdeveloped countries. Physicians need to be aware of the most important clues for diagnosis to avoid delays in diagnosis and treatment. Appropriate replacement therapy is necessary to reduce the morbidity and mortality of patients.