title: Extensive investigation of 114 patients with Sheehan's syndrome: a continuing disorder.
abstract: OBJECTIVE
  Sheehan's syndrome (SS) is a well-known cause of hypopituitarism resulting from postpartum pituitary necrosis. Because of its rarity in Western society, its diagnosis is often overlooked. We aimed to investigate the clinical, laboratory, and radiological aspects of SS in a large number of patients.
  
  
  METHODS
  A retrospective assessment of the medical records of 114 patients with SS was conducted. In addition, sella turcica volumes of 29 healthy women were compared with those of patients by magnetic resonance imaging examinations.
  
  
  RESULTS
  The mean period of diagnostic delay was 19.7 years in patients with SS. It was found that 52.6% of patients had nonspecific complaints, 30.7% had complaints related to adrenal insufficiency, and 9.6% had complaints related to hypogonadism when diagnosed. At the time of diagnosis, 55.3% of the patients had panhypopituitarism, while 44.7% had partial hypopituitarism. The number of deficient hormones was found to be increased over the years. None of the patients whose basal prolactin was below 4.0 ng/ml had adequate prolactin responses to TRH test, while all patients whose basal prolactin was above 7.8 ng/ml had adequate responses. Mean sella volume was found to be significantly lower in the SS group (340.5±214 mm(3)) than that in the healthy group (602.5±192 mm(3)).
  
  
  CONCLUSIONS
  SS is a common cause of hypopituitarism in underdeveloped and developing countries. The main reasons for diagnostic delay seem to be the high frequency of patients with nonspecific complaints and neglect of SS. In addition, the TRH stimulation test was found to have a high sensitivity and specificity to recognize PRL deficiency. Furthermore, small sella size may have an important contributing role in the etiopathogenesis of SS.
authors.affiliation: Departments of EndocrinologyRadiologyErciyes University Medical School, 38039 Kayseri, TurkeyDepartment of EndocrinologyOndokuz Mayis University Medical School, Samsun, Turkey.
authors.forename: Halit
authors.initials: H
authors.lastname: Diri
authors.affiliation: Departments of EndocrinologyRadiologyErciyes University Medical School, 38039 Kayseri, TurkeyDepartment of EndocrinologyOndokuz Mayis University Medical School, Samsun, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Tanriverdi
authors.affiliation: Departments of EndocrinologyRadiologyErciyes University Medical School, 38039 Kayseri, TurkeyDepartment of EndocrinologyOndokuz Mayis University Medical School, Samsun, Turkey.
authors.forename: Zuleyha
authors.initials: Z
authors.lastname: Karaca
authors.affiliation: Departments of EndocrinologyRadiologyErciyes University Medical School, 38039 Kayseri, TurkeyDepartment of EndocrinologyOndokuz Mayis University Medical School, Samsun, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Senol
authors.affiliation: Departments of EndocrinologyRadiologyErciyes University Medical School, 38039 Kayseri, TurkeyDepartment of EndocrinologyOndokuz Mayis University Medical School, Samsun, Turkey.
authors.forename: Kursad
authors.initials: K
authors.lastname: Unluhizarci
authors.affiliation: Departments of EndocrinologyRadiologyErciyes University Medical School, 38039 Kayseri, TurkeyDepartment of EndocrinologyOndokuz Mayis University Medical School, Samsun, Turkey.
authors.forename: Ahmet Candan
authors.initials: AC
authors.lastname: Durak
authors.affiliation: Departments of EndocrinologyRadiologyErciyes University Medical School, 38039 Kayseri, TurkeyDepartment of EndocrinologyOndokuz Mayis University Medical School, Samsun, Turkey.
authors.forename: Hulusi
authors.initials: H
authors.lastname: Atmaca
authors.affiliation: Departments of EndocrinologyRadiologyErciyes University Medical School, 38039 Kayseri, TurkeyDepartment of EndocrinologyOndokuz Mayis University Medical School, Samsun, Turkey fktimur@erciyes.edu.tr.
authors.forename: Fahrettin
authors.initials: F
authors.lastname: Kelestimur
mesh_terms: D000368:Aged; D057210:Delayed Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007018:Hypopituitarism / Q000097:blood* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012658:Sella Turcica / Q000000981:diagnostic imaging