md2bsoon
Forum Newbie
Topics: 5
Posts: 17
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What is the main cause and pathophysiology of Sheehan´s syndrome? Clinical manifestation?
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| Meghna
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Anterior pituitary infarction from severe obstetric shock and postpartum haemorrhage.
In late pregnancy, the anterior pituitary is particularly susceptible to the effects of ischaemia as it may be greatly enlarged from hyperplasia and hypertrophy of the lactotrophs. Postpartum haemorrhage causes rapid depletion of blood volume and systemic hypotension. The blood supply to the anterior pituitary is arrested and infarction ensues. In rare cases, the posterior lobe also may be involved.
The endocrine presentation is variable.
Early symptoms: breast atrophy and failure of lactation, within first 7 days postpartum.
Low TSH: fatigue, slow speech, slow movements, cold intolerance, dry skin, constipation.
Low ACTH: fatigue, hypotension, poor tolerance of stress and infection, hypoglycemia, loss of pubic and axillary hair, decreased body hair, decreased pigment in skin, waxy skin.
Posterior pituitary involvement may result in diabetes insipidus.
Diagnosis: is by having a high index of suspicion and doing pituitary testing:
Draw blood (serum) samples at -30, -15, 0, 15, 30, 45, 60, and 90 minutes, through an indwelling intravenous catheter; at time 0, give I.V.:
1. TRH, 200 ug. This stimulates TSH & PRL release.
2. GnRH, 100 ug. This stimulates LH & FSH release.
3. CRH, 50 ug. This stimulates ACTH release.
4. GHRH, 50 ug. This stimulates the GH release.
Interpretation of the results: all hormones should at least double above mean baseline values. Pulsatile secretion by the pituitary necessitates several baseline values, especially important in dealing with ACTH and FSH.
The condition is effectively treated by appropriate hormone replacement.
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| md2bsoon
Forum Newbie
Topics: 5
Posts: 17
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Good answer 8) Ischemia due to increased metabolic demand of lactotrophs with diminished perfussion.
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