title: Conversion from latent to symptomatic Sheehan's syndrome by pegylated interferon therapy for chronic hepatitis C.
abstract: A 58-year-old woman with chronic hepatitis C was admitted to our hospital to receive interferon (IFN) therapy. Twenty years earlier she had received blood transfusion because of obstetric hemorrhage. Blood test showed mild hypothyroidism and a relatively elevated eosinophil count. Therapy with pegylated IFNalpha-2a was started, and two days later she complained of nausea and severe malaise. Blood test showed hyponatremia, and plasma prolactin, growth hormone and cortisol levels were all decreased. A simultaneous administration test of lutenizing hormone releasing-, corticotrophin releasing-, growth hormone releasing- and thyrotropin releasing-hormones revealed that only adrenocorticotropic hormone was responsive. Magnetic resonance imaging showed atrophy of anterior lobe of pituitary gland. We diagnosed that IFN therapy disclosed latent Sheehan's syndrome due to previous obstetric hemorrhage. Following supplementation of thyroid and adrenal cortical hormones, we were able to complete IFN therapy. Thus, before IFN therapy for woman patients it is important to suspect latent Sheehan's syndrome when the patient had a history of obstetric hemorrhage.
authors.affiliation: Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Kanda
authors.forename: Takahisa
authors.initials: T
authors.lastname: Kayahara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Seno
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Chiba
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D000998:Antiviral Agents / Q000009:adverse effects*; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology* / Q000473:pathology; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects*; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000009:adverse effects*; D006473:Postpartum Hemorrhage / Q000503:physiopathology*; D011994:Recombinant Proteins; D013974:Thyroxine / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000998:Antiviral Agents; D006728:Hormones; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D000324:Adrenocorticotropic Hormone; C100416:peginterferon alfa-2a; D013974:Thyroxine