title: Four decades without diagnosis: Sheehan's syndrome, a retrospective analysis.
abstract: OBJECTIVE
  Sheehan's syndrome (SS) remains a frequent cause of hypopituitarism in undeveloped and developing countries, but due to improvements in obstetric care, it is rare in developed countries. We aimed to share the results of a retrospective study analyzing the demographic, clinical, imaging, and hormonal characteristics of a large group of patients with SS, and also increase awareness of this syndrome especially in developed countries.
  
  
  METHODS
  The medical records of 124 patients with SS patients who were followed up in the Endocrinology Department of Dicle University between 1995 and 2015 were assessed retrospectively.
  
  
  RESULTS
  The mean period of diagnostic delay was 20.37 ± 8.34 years on average. 5.7% of patients with SS were literate; 62% of patients delivered at home. Anemia was identified in 64.5% of SS patients. Mean blood sodium levels were 129.8 ± 11.3 mEq/L. The mean urine densities were 1013 ± 6.5. Osteoporosis and osteopenia were found in 44 (35.4%) and 71 (57.2%) patients, respectively, According to pituitary magnetic resonance imaging (MRI) analyses, 92 (74.2%) patients with SS had completely empty sella, 29 (23.3%) had partially empty sella, and 1 patient had microadenoma, and 2 had normal pituitary MRI results.
  
  
  CONCLUSIONS
  Improved obstetric care and effective interventions for postpartum hemorrhage have limited the prevalence of SS in developed countries. However, in developing countries like Turkey, SS due to postpartum bleeding remains common. Thus, physician's awareness of the symptoms of SS is urgently required to avoid the associated morbidity and mortality.
authors.affiliation: a Department of Endocrinology , Acibadem Medical University , Istanbul , Turkey.
authors.forename: Deniz
authors.initials: D
authors.lastname: Gokalp
authors.affiliation: b Department of Endocrinology , Dicle University School of Medicine , Diyarbakir , Turkey.
authors.forename: Gulistan
authors.initials: G
authors.lastname: Alpagat
authors.affiliation: b Department of Endocrinology , Dicle University School of Medicine , Diyarbakir , Turkey.
authors.forename: Alpaslan
authors.initials: A
authors.lastname: Tuzcu
authors.affiliation: c Izmir Ataturk Education and Research Hospital , Izmir , Turkey.
authors.forename: Mithat
authors.initials: M
authors.lastname: Bahceci
authors.affiliation: d Department of Nuclear Medicine , Diyarbakır Gazi Yasargil Education and Research Hospital , Diyarbakir , Turkey.
authors.forename: Sadiye
authors.initials: S
authors.lastname: Tuzcu
authors.affiliation: e Department of Radiology , Diyarbakir Memorial Hospital , Diyarbakir , Turkey , and.
authors.forename: Fatime
authors.initials: F
authors.lastname: Yakut
authors.affiliation: f Department of Orthopedics , Diyarbakır Gazi Yasargil Education and Research Hospital , Diyarbakir , Turkey.
authors.forename: Azad
authors.initials: A
authors.lastname: Yildirim
mesh_terms: D000328:Adult; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis* / Q000209:etiology*; D020896:Hypovolemia / Q000150:complications*; D008875:Middle Aged; D006473:Postpartum Hemorrhage; D012189:Retrospective Studies; D014421:Turkey
keywords: Hypothalamic amenorrhea; osteoporosis; pituitary gland