Banu ALICIOĞLU, Emrah ÇAĞLAR, Sakin TEKİN, Aykut ALTINOK

Akut Sheehan Sendromlu Bir Olguda Klinik ve Radyolojik Görüntüleme Bulgularının İrdelenmesi

Postpartum hipofizer nekroz ya da Sheehan sendromu (SS), postpartum maternal bakım koşullarındaki yetersizliklere bağlı olarak hipofizer yetersizliğin en sık nedeni olarak görülmektedir. En önemli nedeni doğum sırasında veya doğumdan sonraki masif kanamalardır. Bu yazıda sezaryenle doğum sonrası kanaması olan 35 yaşında hiponatremi ile başvuran ve akut SS tanısı alan olgunun klinik ve radyolojik görüntüleme bulguları sunulmuş ve tartışılmıştır.

Review of Clinical and Radiological Imaging Findings in A Case With Acute Sheeahan’s Syndrome Abstract

Postpartum pituitary necrosis or Sheehan’s syndrome (SS) is the most common cause of pituitary insufficiency in underdeveloped and developing societies due to insufficiency in postpartum maternal care conditions. The most important cause is massive bleeding during or after giving birth a baby. In this report, the clinical and the radiological imaging findings of a 35-year-old patient with postpartum hemorrhage and hyponatremia and diagnosed with acute SS were presented and discussed.

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1. Shivaprasad C. Sheehan’s syndrome: Newer advances. Indian Journal of Endocrinology and Metabolism. 2011; 15(3): 203.
2. Goldman L, Ausiello D. Anterior pituitary. Ünal S, editör. Cecil Textbook of Medicine Türkçe. 23. Baskı. Ankara: Güneş Tıp Kitabevleri; 2011. 1674-1691.
3. Karadağ B, Akçam NY, Döventaş A, Beğer T. Two cases of panhypopituitarism presenting with severe hyponatremia. Turkish Journal of Geriatrics 2005; 8(1): 34-35.
4. Karaca Z, Hacioglu A, Kelestimur F. Neuroendocrine changes after aneurysmal subarachnoid hemorrhage. Pituitary 2019; 22(3): 305-321.
5. Düğeroglu Harun. Sheehan sendromu. Klinik Tıp Aile Hekimliği 2018; 10(3): 31-32.
6. Karaca Z, Laway BA, Dokmetas HS, Atmaca H, Kelestimur F. Sheehan syndrome. Nat Rev Dis Primers 2016; 22(2): 16092.
7. Abs R, Bengtsson BÅ, Hernberg‐Ståhl E, Monson JP, Tauber JP, Wilton P, Wüster C. GH replacement in 1034 growth hormone deficient hypopituitary adults: Demographic and clinical characteristics, do sing and safety. Clinical Endocrinology 1999; 50(6): 703-713.
8. Woodmansee WW. Pituitary disorders in pregnancy. Neurologic Clinics 2019; 37(1): 63-83.
9. Tıkır B, Göka E, Aydemir MÇ, Gürkan Ş. Psychotic disorderand sheehan’s syndrome: Etiology or comorbidity?: A case report. Turk Psikiyatri Derg 2015; 26(2): 142-145.
10. Schrager S, Sabo L. Sheehan syndrome: A rare complication of postpartum hemorrhage. Madison J Am Board Fam Med 2001; 14(5): 390.
11. Yatagai T, Kusaka I, Nakamura T, et al. Close association of severe hyponatremia with exaggerated release of arginine vasopressin in elderly subjects with secondary adrenal insufficiency. European Journal of Endocrinology 2003; 148(2): 221-226.
12. Drummond JB, Ribeiro-Oliveira A, Soares BS. Non-Functioning Pituitary Adenomas. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A, Hershman JM, Kaltsas G, Koch C, Kopp P, Korbonits M, McLachlan R, Morley JE, New M, Perreault L, Purnell J, Rebar R, Singer F, Trence DL, Vinik A, Wilson DP, editors. Endotext [Internet]. MDText.com, Inc.; South Dartmouth (MA): Nov 28, 2018.
13. Bayraktaroglu T, Colak N, Nalcaci M, Yenerel MN. Sheehan’s syndrome associated with glanzmann’s thrombasthenia: Case report and literature review. Exp Clin Endocrinol Diabetes 2008; 116(9): 549-553.
14. Olıveıra, Miriam C, et al. Acquired factor VIII and von willebrand factor (aFVIII/VWF) deficiency and hypothyroidism in a case with hypopituitarism. Clinical and Applied Thrombosis/Hemostasis 2010; 16(1): 107-109.
15. LAWAY, Bashir Ahmad, et al. Prevalence of hematological abnormalities in patients with Sheehan’s syndrome: Response to replacement of glucocorticoids and thyroxine. Pituitary 2011; 14(1): 39-43.
16. Chiloiro S, Tartaglione T, Angelini F, Bianchi A, Arena V, Giampietro A, Mormando M, Sciandra M, Laino ME, De Marinis L. An overview of diagnosis of primary auto immune hypophysitis in a prospective single-center experience. Neuroendocrinology 2017; 104(3): 280-290.
17. Maccagnan P, Oliveira JHA, Castro V, Abucham J. Abnormal circadian rhythm and increasednon‐pulsatile secretion of thyrotrophin in Sheehan’s syndrome. Clinical Endocrinology 1999; 51(4): 439-447.
18. Abs R, Bengtsson BA, Hernberg-Stâhl E, Monson JP, Tauber JP, Wilton P, et al. GH replacement in 1034 growth hormone deficient hypopituitary adults: Demographic and clinical characteristics, dosing and safety. Clin Endocrinol (Oxf) 1999; 50(6): 703-713.
19. Kanekar S, Bennett S. Imaging of neurologic conditions in pregnant patients. Radiographics 2016; 36(7): 2102-2122.
20. Miljic D, Pekic S, Popovic V. EmptySella. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A, Hershman JM, Kaltsas G, Koch C, Kopp P, Korbonits M, McLachlan R, Morley JE, New M, Perreault L, Purnell J, Rebar R, Singer F, Trence DL, Vinik A, Wilson DP, editors. Endotext [Internet]. MDText.com, Inc.; South Dartmouth (MA): Oct 1, 2018.
21. Chong BW, Newton TH. Hypothalamic and pituitary pathology. Radiologic Clinics of North America 1993; 31(5): 1147-1153.
22. Sherif IH, Vanderley CM, Beshyah S, Bosairi S. Sella size andcontents in Sheehan’s syndrome. Clin Endocrinol (Oxf) 1989; 30: 613-618.
23. Bakiri F, Bendib SE, Maoui R, Bendib A, Benmiloud M. Thesellaturcica in Sheehan’s syndrome: Computerized tomographic study in 54 patients. J Endocrinol Invest 1991; 14: 193-196.
24. Karaca Z, Tanriverdi F, Unlu hizarci K, Kelestimur F, Donmez H. Empty sella may be the final outcome in lymphocytic hypophysitis. Endocr Res 2009; 34(1-2): 10-17.
25. Fleseriu M, Hashim IA, Karavitaki N, Melmed S, Murad MH, Salvatori R, Samuels MH. Hormonal replacement in hypopituitarism in adults: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2016; 101: 3888-3921.
26. Keleştimur F, Auernhammer C, Çolak R, et al. The baseline characteristics and the effects of GH replacement therapy in patients with Sheehan’s syndrome as compared to nonfunctioning pituitary adenoma. The Endocrine Society’s 85th Annual Meeting Philadelphia, USA 2003: 19-22.