Sheehan's syndrome of more than 30 years' duration: an endocrine and MRI study of 6 cases
Sheehan's syndrome of more than 30 years' duration: an endocrine and MRI study of 6 cases
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DOI：
10.1507/endocrj.45.451
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发表时间：
1998-08-01
影响因子：
2
通讯作者：
Makino, H
中科院分区：
文献类型：
--
作者：
Otsuka, F;Kageyama, J;Makino, H
对发病30年以上的Sheehan综合征患者的内分泌功能和垂体显像学进行评估。对6例Sheehan综合征患者进行了磁共振成像(MRI)、垂体前叶联合试验、血浆血管加压素-渗透压适应性研究、抗甲状腺抗体和抗垂体细胞抗体检测。从分娩到出现激素缺乏症状的间隔时间为3到32年。自临床起病以来，所有患者均接受了糖皮质激素和甲状腺替代治疗。头颅MRI检查显示5例为“空鞍区”。其中2例(40%)表现为全垂体功能减退，其余3例(60%)维持促性腺激素反应。在维持PRL和促性腺激素反应的患者中，正常情况下可辨认出脑下垂体，但在T1加权像上有低信号损害。6例患者中，3例(50%)无多尿，但垂体后叶功能异常。所有病例均未检测到抗垂体抗体。甲状腺过氧化物酶抗体均为阴性，抗甲状腺球蛋白抗体阳性2例(33%)。未检测到促甲状腺抗体，但1例有抗TSH抗体。发病30年后，大多数Sheehan综合征患者在MRI上显示空鞍区的迹象，均有明显的垂体前和/或后叶激素抑制，与自身免疫无关。
The endocrine function and pituitary imaging in Sheehan's syndrome more than 30 years after causative events were evaluated. Magnetic resonance imaging (MRI), a combined anterior pituitary test, plasma vasopressin-to-osmolality adaptation study, and antithyroid and antipituitary cell antibody measurement were performed in 6 women with Sheehan's syndrome. The interval from delivery to the onset of symptoms of hormonal deficiency ranged from 3 to 32 years. Since clinical onset, all had received glucocorticoid and thyroid replacement therapy. Cranial MRI examination showed an "empty sella" in 5 cases. Among these, 2 of 5 (40%) demonstrated panhypopituitarism and the other 3 (60%) maintained gonadotropin response. The pituitary gland was normally discernible but with a low-intensity lesion on T1-weighted images in a patient who maintained PRL and gonadotropin responses. Posterior pituitary function was abnormal in 3 of 6 (50%) despite the absence of polyuria. No antipituitary antibodies were detected in any of the cases. Thyroid peroxidase antibody was negative in all cases, but antithyroglobulin antibody was detected in 2 of 6 (33%). Thyroid-stimulating antibody was not detected, but one case had an anti-TSH antibody. Thirty years after the initial events, most patients with Sheehan's syndrome showed signs of an empty sella on MRI, all having noticeable suppression of anterior and/or posterior pituitary hormones with no related autoimmunity.