A case of acute Sheehan's syndrome and literature review: a rare but life-threatening complication of postpartum hemorrhage.
A case of acute Sheehan's syndrome and literature review: a rare but life-threatening complication of postpartum hemorrhage.
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DOI：
10.1186/s12884-017-1380-y
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发表时间：
2017-06-14
影响因子：
3.1
通讯作者：
Kimura T
中科院分区：
文献类型：
--
作者：
Matsuzaki S;Endo M;Ueda Y;Mimura K;Kakigano A;Egawa-Takata T;Kumasawa K;Yoshino K;Kimura T
希恩综合征的发生是由于严重的产后出血导致脑下垂体缺血性坏死。希恩综合征是一种众所周知的疾病，通常在产后几年被诊断出来。然而，急性希恩综合征是罕见的，临床医生几乎没有接触到它。这可能会危及生命。目前还没有关于急性希恩综合征的综述，也没有关于急性希恩综合征后成功怀孕的报道。我们提出了这样一个病例，为了了解这种罕见的情况，我们回顾和讨论了与之相关的文献。对1990年1月至2014年5月的文献中的急性希恩综合征进行电子检索。一名27岁的妇女在第一次分娩时因无张力出血而大量产后出血(约5000毫升)。她接受了输血和子宫栓塞术，成功止住了出血。产后至出血后第7天无并发症。然而，在第8天，患者突然发作癫痫，随后进入昏迷状态。实验室结果显示甲状腺功能减退、低血糖、低催乳素血症和肾上腺功能不全。因此，患者被诊断为急性希恩综合征。在接受甲状腺素和氢化可的松治疗后，她的病情有所改善，并于第24天出院。她的下一次怀孕是在第一次分娩两年后确定的。她需要为下一次受孕进行排卵诱导。怀孕、分娩和产后期都很顺利。对文献进行电子搜索，发现21例急性希恩综合征。临床表现多样，包括肾上腺功能不全(12例)、尿崩症(4例)、甲状腺功能减退症(2例)、全垂体功能减退症(3例)，产后出现症状的中位时间分别为7.9、4、18和9天。报告了一些急性Sheehan综合征的磁共振成像的一系列改变。临床医生应该意识到产后大出血后发生急性希恩综合征的风险，以便准确诊断并及时治疗。
Sheehan’s syndrome occurs because of severe postpartum hemorrhage causing ischemic pituitary necrosis. Sheehan’s syndrome is a well-known condition that is generally diagnosed several years postpartum. However, acute Sheehan’s syndrome is rare, and clinicians have little exposure to it. It can be life-threatening. There have been no reviews of acute Sheehan’s syndrome and no reports of successful pregnancies after acute Sheehan’s syndrome. We present such a case, and to understand this rare condition, we have reviewed and discussed the literature pertaining to it. An electronic search for acute Sheehan’s syndrome in the literature from January 1990 and May 2014 was performed. A 27-year-old woman had massive postpartum hemorrhage (approximately 5000 mL) at her first delivery due to atonic bleeding. She was transfused and treated with uterine embolization, which successfully stopped the bleeding. The postpartum period was uncomplicated through day 7 following the hemorrhage. However, on day 8, the patient had sudden onset of seizures and subsequently became comatose. Laboratory results revealed hypothyroidism, hypoglycemia, hypoprolactinemia, and adrenal insufficiency. Thus, the patient was diagnosed with acute Sheehan’s syndrome. Following treatment with thyroxine and hydrocortisone, her condition improved, and she was discharged on day 24. Her next pregnancy was established 2 years after her first delivery. She required induction of ovulation for the next conception. The pregnancy, delivery, and postpartum period were uneventful. An electronic search of the literature yielded 21 cases of acute Sheehan’s syndrome. Presenting signs varied, including adrenal insufficiency (12 cases), diabetes insipidus (4 cases), hypothyroidism (2 cases), and panhypopituitarism (3 cases), with a median time of presentation after delivery for each of those conditions being 7.9, 4, 18, and 9 days, respectively. Serial changes in magnetic resonance imaging were reported in some cases of acute Sheehan’s syndrome. Clinicians should be aware of the risk of acute Sheehan’s syndrome after a massive postpartum hemorrhage in order to diagnose it accurately and treat it promptly.