Kageyama Y, Hirose S, Terashi K, Nakayama S, Komatsuzaki O, Fukuda H
Department of Internal Medicine, Tochigi National Hospital, Utsunomiya, Japan.
Jpn J Med. 1988 Aug;27(3):337-41. doi: 10.2169/internalmedicine1962.27.337.
A case of a 69-year-old woman with postpartum hypopituitarism (Sheehan's syndrome) associated with congestive heart failure and severe hyponatremia is reported. She developed congestive heart failure after cholecystectomy, and marked improvement was noted by treatment with oxygen, digoxin, furosemide, and dopamine. Two weeks after surgery, she became confused, and hyponatremia, 106 mEq/l, was detected. She was referred to us. Past history revealed postpartum hemorrhage at the age of 34, followed by a failure to lactate, menoschesis, and loss of pubic hair and axillary hair. Hypertonic saline (1.5%) infusion and water restriction increased her serum sodium concentration into the low normal range. Despite hyponatremia, serum vasopressin was not suppressed. Basal levels of pituitary hormones were low, and they did not respond to provocation tests. Marked impairment of water excretion was noted, and plasma vasopressin was not suppressed during a water-loading test. These results suggest that inappropriately increased vasopressin played an important role in impaired water excretion, and this defect could have been responsible for the development of hyponatremia and congestive heart failure in this patient.
报告了一例69岁女性产后垂体功能减退（希恩综合征）合并充血性心力衰竭和严重低钠血症的病例。她在胆囊切除术后出现充血性心力衰竭，经吸氧、地高辛、呋塞米和多巴胺治疗后有明显改善。术后两周，她出现意识模糊，检测发现低钠血症，血钠浓度为106 mEq/l。她被转诊至我们这里。既往史显示，她34岁时发生产后出血，随后出现泌乳失败、闭经以及阴毛和腋毛脱落。输注高渗盐水（1.5%）并限制饮水使她的血清钠浓度升至低正常范围。尽管存在低钠血症，但血清血管加压素未被抑制。垂体激素基础水平较低，且对激发试验无反应。观察到水排泄明显受损，在水负荷试验期间血浆血管加压素未被抑制。这些结果表明，血管加压素不适当增加在水排泄受损中起重要作用，这种缺陷可能是该患者发生低钠血症和充血性心力衰竭的原因。
