Sethuram Ramya, Guilfoil Daniel S, Amori Renee, Kharlip Julia, Berkowitz Karen M
Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA.
Womens Health Rep (New Rochelle). 2020 Aug 24;1(1):287-292. doi: 10.1089/whr.2019.0028. eCollection 2020.
Sheehan syndrome (SS) is a rare complication of severe postpartum hemorrhage or hypotension during the processes of labor and delivery that results in ischemic pituitary infarction and necrosis. In this case report, we describe an unusual presentation of SS without inciting factors. A 30-year-old multiparous woman presented 2 hours after a normal spontaneous vaginal delivery with a profound severe headache, and subsequent agalactia, dry skin, and mood changes. She was managed conservatively until 10 months postdelivery when she complained of persistent symptoms including amenorrhea. A brain magnetic resonance (MR) with pituitary imaging revealed findings consistent with SS. The patient's symptoms improved and ultimately resolved after levothyroxine, estrogen replacement therapy, and hydrocortisone were instituted. SS can present without recognized inciting factors. During the initial phase, women may present with profound headache and/or visual disturbances warranting neurological evaluation. A high index of suspicion and a brain MR with pituitary imaging should prompt early consideration of SS to aid in the diagnosis.
席汉综合征（SS）是分娩过程中严重产后出血或低血压的一种罕见并发症，可导致垂体缺血性梗死和坏死。在本病例报告中，我们描述了一例无诱发因素的席汉综合征异常表现。一名30岁经产妇在正常自然阴道分娩2小时后出现严重头痛，随后出现无乳、皮肤干燥和情绪变化。她接受了保守治疗，直到产后10个月，她抱怨持续出现包括闭经在内的症状。脑部磁共振成像（MR）及垂体成像显示结果与席汉综合征相符。在开始使用左甲状腺素、雌激素替代疗法和氢化可的松后，患者的症状有所改善并最终消失。席汉综合征可在无公认诱发因素的情况下出现。在初始阶段，女性可能会出现严重头痛和/或视觉障碍，需要进行神经学评估。高度怀疑并结合脑部MR及垂体成像应促使早期考虑席汉综合征以辅助诊断。
