Sheehan syndrome in Costa Rica: clinical experience with 60 cases.
OBJECTIVE
To describe the clinical and hormonal characteristics of patients with Sheehan syndrome.


METHODS
We performed a 20-year cohort study (1969 to 1989) of patients with Sheehan syndrome who were cared for in the endocrinology unit of the México Hospital in San José, Costa Rica. Medical history, physical examination findings, and laboratory test results were documented and reviewed.


RESULTS
Sixty patients with a diagnosis of Sheehan syndrome were identified. Mean age at diagnosis was 45.8 ± 10.6 years. The average time between the previous obstetric event and Sheehan syndrome diagnosis was 13 years. Thirteen patients (22%) had a home birth. The median parity was 7. The most frequent obstetric antecedents were history of obstetric hemorrhage in 49 (82%), shock in 28 (47%), blood transfusion in 26 (43%), and peripartum hysterectomy in 4 (7%). The most common symptoms included asthenia and adynamia in 51 (85%), amenorrhea in 44 (73%), loss of axillary or pubic hair in 40 (67%), and agalactia in 40 (67%). The most common findings on physical examination were absence of axillary hair in 56 (93%) and pubic hair in 56 (93%), dry skin in 49 (82%), and pallor in 42 (70%). When a combined pituitary test was performed, 38 of 38 patients (100%) had human growth hormone deficiency, 29 of 30 patients (97%) had adrenal insufficiency, 8 of 10 patients (80%) had hypothyroidism, 8 of 12 patients (67%) had hypogonadism, and 9 of 13 patients (69%) had prolactin deficiency. Despite early onset of symptoms, Sheehan syndrome was diagnosed relatively late in these 60 patients. Hemorrhage during the last delivery, especially if severe and/or associated with shock or transfusion, was the most important obstetric antecedent event. Absence of amenorrhea or presence of postpartum lactation did not exclude the diagnosis. Abnormal responses of human growth hormone to insulin tolerance testing and of prolactin to thyrotropin-releasing hormone confirm the diagnosis.


CONCLUSIONS
Identification of patients affected with Sheehan syndrome is critical to avoid delays in diagnosis and treatment. Appropriate replacement therapy is capable of yielding complete remission of symptoms.
University of Costa Rica, San José, Costa Rica. orlandogeiguardia@gmail.com
Orlando
O
Gei-Guardia
Esteban
E
Soto-Herrera
Alfredo
A
Gei-Brealey
Chih Hao
CH
Chen-Ku
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003364:Costa Rica / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006728:Hormones / Q000097:blood; D006801:Humans; D007018:Hypopituitarism / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D058725:Peripartum Period / Q000097:blood / Q000502:physiology; D006473:Postpartum Hemorrhage / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult
D006728:Hormones