HYPOPITUITARISM POSPARTUM.

SHEEHAN SYNDROME
Authors: Luna M V, Lemaitre N, Cataln J, Payeras B
Sheehan's syndrome is a rare entity, described in 1937, characterized by agalactia and hypopituitarism in
patients who had a severe uterine bleeding peripartum being proposed pathogenesis ischemic pituitary
necrosis.
This is a retrospective study, 9 patients admitted to the medical clinic room Padilla Hospital San Miguel de
Tucumn, subsequent to dystocia (with severe uterine bleeding) were included. The age range of the
included patients was between 23 and 45 years, with a median of 33.8. In all cases of patients treated for
low-income and low-literacy, who had not made adequate prenatal care. Lack of body hair of patients were
photographically observed.
The admission in all cases was amenorrhea, agalactia, mucocutaneous pallor, loss of pubic and axillary hair,
and in one case also severe hypoglycemia and sepsis, which caused the death afterwards. An important fact
is observed that the average time from birth to the time of diagnosis was 7.28 years, which marks a
significant delay to get a definitive diagnosis. In 9 patients confirmed biochemically anemic syndrome, and in
two cases the serum sodium was altered. With respect to the basal values hormone cortisol was decreased in
all cases, allowing to reach failure diagnosis with baseline measurements adrenal axis, and only needed
testing stimulus effect in both cases, and these also pathological findings. The thyroid axis was normal for all
patients; but it is important to clarify that this axis was not evaluated correctly if it was thought to rule out a
secondary thyroid failure. Evaluation of gonadal axis confirmed hypogonadotropic hypogonadism. Failed to
evaluate the somatotropic axis. Regarding treatment the adrenal axis hormone replacement was done in all
cases, as well as the failure of secondary mineral metabolism, with good tolerance and clinical improvement
in all cases.
Conclusions: The patients were carriers of pituitary failure of ischemic cause necrotic or postpartum
(Sheehan syndrome). The delay so far diagnosis was important due to the initial signs of disease overlapped.
That is why we must remember that only you can make the diagnosis of this entity if you think about its
existence. The incidence of this disease in our country is increasing, even when compared with developed
countries, so it is important to work together to improve antenatal patients taking preventive medicine
occupies a role privilege.

HIPOPITUITARISMO POSPARTO. SNDROME DE SHEEHAN
Autores: Luna M V, Lemaitre N, Cataln J, Payeras B
El sndrome de Sheehan es una entidad poco frecuente, descripta en 1937, caracterizado por agalactia e
hipopituitarismo en pacientes que tuvieron una hemorragia uterina severa periparto, siendo la patognesis
propuesta la necrosis isqumica hipofisaria.
La amenorrea, agalactia, palidez cutneo-mucosa, prdida de vello pubiano y axilar, y en un caso adems
hipoglucemia severa y sepsis. Los valores hormonales el cortisol basal estuvo descendido en todos los casos,
permitiendo llegar al diagnstico de falla del eje suprarrenal con determinaciones basales, y solo se
necesitaron efectuar pruebas de estmulo en dos casos, siendo estos resultados tambin patolgicos. El eje
tiroideo estuvo normal en todas las pacientes; pero este eje no fue valorado correctamente si se pensaba
descartar una falla tiroidea secundaria. La evaluacin del eje gonadal confirm hipogonadismo
hipogonadotrfico. No se pudo valorar el eje somatotropo. Respecto al tratamiento la sustitucin hormonal
del eje adrenal fue hecha en todos los casos, como as tambin el de la falla secundaria del metabolismo
fosfoclcico, con buena tolerancia y mejora del cuadro clnico en todos los casos.