Clinical, hormonal and radiological features of partial Sheehan’s syndrome: an Indian experience

Laway, Bashir; Misgar, Raiz; Mir, Shahnaz; Wani, Arshad

doi:10.1590/2359-3997000000137

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Archives of Endocrinology and Metabolism

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Original Articles • Arch. Endocrinol. Metab. 60 (2) • Apr 2016 • https://doi.org/10.1590/2359-3997000000137 copy

Clinical, hormonal and radiological features of partial Sheehan’s syndrome: an Indian experience

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

The objective of this study was to describe clinical presentation, hormonal profile and imaging characteristics of 21 patients with partial Sheehan’s syndrome.

Subjects and methods

This prospective study was carried out over a period of six years (2008-2013). The evaluation of patients included clinical assessment, hormone estimations and contrast enhanced magnetic resonance imaging of pituitary.

Results

We documented preservation of gonadotroph, corticotroph and lactotroph function in 71.4, 61.9, and 9.5% of patients respectively.

Conclusion

To conclude some of the pituitary functions can be preserved in Sheehan’s syndrome and this has important implications from the treatment and long term morbidity point of view.

Sheehan’s syndrome; post partum hemorrhage; partial Sheehan’s syndrome

Case	Age	Parity	PPH	BT	LTF	TTF	STF	CTF	GTF	MRI
1	36	4	+	+	+	+	+	–	–	ES
2	35	1	+	+	+	+	+	–	+	ES
3	45	3	+	+	+	+	+	–	+	ES
4	50	3	+	+	+	+	+	–	–	ES
5	30	2	–	–	–	+	+	+	–	ES
6	45	4	+	–	+	+	+	+	–	ES
7	45	3	–	–	+	+	+	–	–	ES
8	40	4	+	+	+	+	+	+	–	ES
9	42	1	+	+	+	+	+	–	–	ES
10	40	3	+	–	+	+	+	–	–	ES
11	50	3	+	+	–	+	+	+	–	ES
12	40	2	+	+	+	+	+	–	+	ES
13	60	3	+	–	+	+	+	+	–	ES
14	35	1	+	+	+	+	+	-		ES
15	30	1	+	+	+	+	+	_	_	ES
16	35	2	+	+	+	+	+	+	-	ES
17	45	2	+	+	+	+	+	+	-	ES
18	25	3	+	+	+	+	+	+	-	ES
19	30	4	-	-	+	+	+	-	+	ES
20	38	4	+	-	+	+	+	-	+	ES
21	30	3	+	+	+	+	+	-	+	ES

Hormone	T4 µg/dL	TSH µIU/mL	LH IU/L	FSH IU/L	PRL µg/L	GH µg/L	Cortisol µg/dl
Normal value	5.5-13.5	0.5-6.5	3-12	2-6.6	> 2 fold* increase	> 3*	> 20*
Case 1	3.2	5.9	6.5	10.2	4*	2.2*	20.1*
Case 2	1	4.9	11.28	1.47	2.03*	1*	21.83*
Case 3	4.35	3.6	5.22	8.9	5.41*	1*	20.22*
Case 4	3.7	7.9	1.6	6.2	4.79*	1*	28*
Case 5	1	7.7	4.89	9.49	22*	1*	15*
Case 6	2.7	5.9	6.7	9.8	4.6*	1*	8.25*
Case 7	1	5.86	6.3	8.3	3.85*	1*	24.75*
Case 8	3.2	6.2	4.5	5.8	3.45*	1*	3.8*
Case 9	1.7	2.54	1.62	2.75	0.5*	1*	21.2*
Case 10	2	4.6	4.24	3.54	3.84*	1*	22.6*
Case 11	1.6	8.2	5.9	10.2	14.2*	1*	13*
Case 12	2.3	4.9	3.8	4.7	3*	0.8*	24*
Case 13	1.2	9.2	8.52	13.3	2.83*	0.7*	11.2*
Case 14	1.4	5.2	3.4	5.3	2.3*	< 1*	19.5*
Case 15	2.26	1.8	2.24	4.94	2.04	< 1*	26.05^±
Case 16	2.1	6.2	5.3	4.2	2	< 1*	5.2*
Case 17	< 1	4.63	5.8	3.2	3.58*	< 1*	8.25*
Case 18	< 1	6.7	1	3.79	3.49*	< 0.25*	9.96*
Case 19	1.50	3.45	0.98	3.15	-	1.25	17.41*
Case 20	1.15	0.15	1.71	2.06	< 1.5*	< 0.25*	20.74*
Case 21	2.91	3.24	< 1.5	< 1.5	-	< 0.25	21.3

Author	Year	No	Somatotroph	Lactotroph	Gonadotroph	Thyrotroph	Corticotroph
Dash and cols.	1993	19	100	90	85	100	100
Zargar and cols.	1996	86	100	94.19	92.6	85.7	84.4
Goswami and cols.	2002	19	-	-	94.8	100	94.8
Sert and cols.	2003	20	100	92.8	100	100	100
Dökmetaş and cols.	2006	28	100	93	100	90	100
Laway and cols.	2011	10	100	100	30	100	50
Gei-Guardia and cols.	2011	60	100	69.2	75	80	96.6
Diri and cols.	2014	114	100	71.1	100	90.4	71.9
Present series	2014	21	100	90	28	100	38

Sociedade Brasileira de Endocrinologia e Metabologia Rua Botucatu, 572 - Conjuntos 81/83, 04023-061 São Paulo SP Brasil, Tel: (55 11) 5575-0311 - São Paulo - SP - Brazil
E-mail: aem.editorial.office@endocrino.org.br

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[1] Correspondence to: Bashir Ahmad Laway, Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India. drlaway@gmail.com

Case	Age	Parity	PPH	BT	LTF	TTF	STF	CTF	GTF	MRI
1	36	4	+	+	+	+	+	–	–	ES
2	35	1	+	+	+	+	+	–	+	ES
3	45	3	+	+	+	+	+	–	+	ES
4	50	3	+	+	+	+	+	–	–	ES
5	30	2	–	–	–	+	+	+	–	ES
6	45	4	+	–	+	+	+	+	–	ES
7	45	3	–	–	+	+	+	–	–	ES
8	40	4	+	+	+	+	+	+	–	ES
9	42	1	+	+	+	+	+	–	–	ES
10	40	3	+	–	+	+	+	–	–	ES
11	50	3	+	+	–	+	+	+	–	ES
12	40	2	+	+	+	+	+	–	+	ES
13	60	3	+	–	+	+	+	+	–	ES
14	35	1	+	+	+	+	+	-		ES
15	30	1	+	+	+	+	+	_	_	ES
16	35	2	+	+	+	+	+	+	-	ES
17	45	2	+	+	+	+	+	+	-	ES
18	25	3	+	+	+	+	+	+	-	ES
19	30	4	-	-	+	+	+	-	+	ES
20	38	4	+	-	+	+	+	-	+	ES
21	30	3	+	+	+	+	+	-	+	ES

Case	Age	Parity	PPH	BT	LTF	TTF	STF	CTF	GTF	MRI
1	36	4	+	+	+	+	+	–	–	ES
2	35	1	+	+	+	+	+	–	+	ES
3	45	3	+	+	+	+	+	–	+	ES
4	50	3	+	+	+	+	+	–	–	ES
5	30	2	–	–	–	+	+	+	–	ES
6	45	4	+	–	+	+	+	+	–	ES
7	45	3	–	–	+	+	+	–	–	ES
8	40	4	+	+	+	+	+	+	–	ES
9	42	1	+	+	+	+	+	–	–	ES
10	40	3	+	–	+	+	+	–	–	ES
11	50	3	+	+	–	+	+	+	–	ES
12	40	2	+	+	+	+	+	–	+	ES
13	60	3	+	–	+	+	+	+	–	ES
14	35	1	+	+	+	+	+	-		ES
15	30	1	+	+	+	+	+	_	_	ES
16	35	2	+	+	+	+	+	+	-	ES
17	45	2	+	+	+	+	+	+	-	ES
18	25	3	+	+	+	+	+	+	-	ES
19	30	4	-	-	+	+	+	-	+	ES
20	38	4	+	-	+	+	+	-	+	ES
21	30	3	+	+	+	+	+	-	+	ES

Case	Age	Parity	PPH	BT	LTF	TTF	STF	CTF	GTF	MRI
1	36	4	+	+	+	+	+	–	–	ES
2	35	1	+	+	+	+	+	–	+	ES
3	45	3	+	+	+	+	+	–	+	ES
4	50	3	+	+	+	+	+	–	–	ES
5	30	2	–	–	–	+	+	+	–	ES
6	45	4	+	–	+	+	+	+	–	ES
7	45	3	–	–	+	+	+	–	–	ES
8	40	4	+	+	+	+	+	+	–	ES
9	42	1	+	+	+	+	+	–	–	ES
10	40	3	+	–	+	+	+	–	–	ES
11	50	3	+	+	–	+	+	+	–	ES
12	40	2	+	+	+	+	+	–	+	ES
13	60	3	+	–	+	+	+	+	–	ES
14	35	1	+	+	+	+	+	-		ES
15	30	1	+	+	+	+	+	_	_	ES
16	35	2	+	+	+	+	+	+	-	ES
17	45	2	+	+	+	+	+	+	-	ES
18	25	3	+	+	+	+	+	+	-	ES
19	30	4	-	-	+	+	+	-	+	ES
20	38	4	+	-	+	+	+	-	+	ES
21	30	3	+	+	+	+	+	-	+	ES