Sheehan's syndrome of more than 30 years' duration: an endocrine and MRI study of 6 cases.
The endocrine function and pituitary imaging in Sheehan's syndrome more than 30 years after causative events were evaluated. Magnetic resonance imaging (MRI), a combined anterior pituitary test, plasma vasopressin-to-osmolality adaptation study, and antithyroid and antipituitary cell antibody measurement were performed in 6 women with Sheehan's syndrome. The interval from delivery to the onset of symptoms of hormonal deficiency ranged from 3 to 32 years. Since clinical onset, all had received glucocorticoid and thyroid replacement therapy. Cranial MRI examination showed an "empty sella" in 5 cases. Among these, 2 of 5 (40%) demonstrated panhypopituitarism and the other 3 (60%) maintained gonadotropin response. The pituitary gland was normally discernible but with a low-intensity lesion on T1-weighted images in a patient who maintained PRL and gonadotropin responses. Posterior pituitary function was abnormal in 3 of 6 (50%) despite the absence of polyuria. No antipituitary antibodies were detected in any of the cases. Thyroid peroxidase antibody was negative in all cases, but antithyroglobulin antibody was detected in 2 of 6 (33%). Thyroid-stimulating antibody was not detected, but one case had an anti-TSH antibody. Thirty years after the initial events, most patients with Sheehan's syndrome showed signs of an empty sella on MRI, all having noticeable suppression of anterior and/or posterior pituitary hormones with no related autoimmunity.
Otsuka
F
F
Department of Medicine III, Okayama University Medical School, Okayama City, Japan.
Kageyama
J
J
Ogura
T
T
Hattori
T
T
Makino
H
H
D000368:Aged; D001323:Autoantibodies / Q000032:analysis; D001921:Brain / Q000473:pathology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007018:Hypopituitarism / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010901:Pituitary Function Tests; D010902:Pituitary Gland / Q000276:immunology / Q000473:pathology*; D012964:Sodium / Q000627:therapeutic use; D013961:Thyroid Gland / Q000276:immunology; D013974:Thyroxine / Q000627:therapeutic use
D001323:Autoantibodies; D012964:Sodium; D013974:Thyroxine; D006854:Hydrocortisone