title: [Irreversible coma following hypoglycemia in Sheehan syndrome with adrenocortical insufficiency].
abstract: A 24-year-old woman of Somali origin delivered at term after an uncomplicated pregnancy. Post-partum haemorrhage resulted in hypovolaemic shock which was treated by hysterectomy. Five days later she became comatose due to unrecognised hypoglycaemia which caused severe irreversible brain damage and status epilepticus. Treatment in the intensive care unit with artificial respiration, prednisolone, desmopressin, inotropic support, barbiturates and an anaesthetic under EEG guidance was unsuccessful. The patient died 28 days post-partum. The hypoglycaemia was due to a combination of (a) inadequate glucose intake and (b) lack of counter-regulatory mechanisms due to a deficiency of steroids and growth hormone as a result of loss of pituitary function (Sheehan syndrome) together with adrenocortical insufficiency. The combination of Sheehan syndrome and primary adrenocortical insufficiency has not been described previously in the literature.
authors.affiliation: Afd. Neurologische en Neurochirurgische Intensive Care, Erasmus Medisch Centrum, Rotterdam.
authors.forename: A M
authors.initials: AM
authors.lastname: Sas
authors.forename: I A
authors.initials: IA
authors.lastname: Meynaar
authors.forename: J S
authors.initials: JS
authors.lastname: Laven
authors.forename: S L
authors.initials: SL
authors.lastname: Bakker
authors.forename: R A
authors.initials: RA
authors.lastname: Feelders
mesh_terms: D000309:Adrenal Insufficiency / Q000150:complications* / Q000188:drug therapy; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003128:Coma / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000150:complications* / Q000188:drug therapy; D007018:Hypopituitarism / Q000150:complications* / Q000188:drug therapy; D007044:Hysterectomy; D006473:Postpartum Hemorrhage / Q000150:complications / Q000209:etiology / Q000601:surgery*; D011241:Prednisone / Q000627:therapeutic use; D011247:Pregnancy; D012769:Shock / Q000209:etiology / Q000601:surgery
chemical_list: D001786:Blood Glucose; D005938:Glucocorticoids; D011241:Prednisone
vernacular_title: Irreversibel coma na hypoglykemie bij het syndroom van Sheehan met bijnierschorsinsufficiëntie.