Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany.
Department of Internal Medicine IV - Nephrology, Saarland University Hospital, Homburg, Germany.
Arch Gynecol Obstet. 2022 Sep;306(3):699-706. doi: 10.1007/s00404-021-06294-2. Epub 2021 Nov 15.
Acute Sheehan's syndrome is a rare, but potentially life-threatening, obstetric event that can be complicated by diabetes insipidus. Little information on the diagnosis and treatment of Sheehan's syndrome with diabetes insipidus is available. We report on a 28-year-old patient who developed acute Sheehan's syndrome with diabetes insipidus after giving birth, and on a systematic review of similar cases.
We performed a systematic review of the literature cataloged in PubMed and Google Scholar using the keywords "Sheehan syndrome" OR "Sheehan's syndrome" AND "diabetes insipidus" to identify relevant case reports published between 1990 and 2021. Eight Reports met the inclusion criteria (English-language abstracts available, onset in the puerperium, information about the day of the onset).
In the present case, postpartum curettage was necessary to remove the residual placenta. The total amount of blood loss was severe (2500 ml). On the second day postpartal, the patient developed polyuria. Laboratory analysis revealed hypernatremia with increased serum osmolality and decreased urinary osmolality. Hormone analysis showed partial hypopituitarism involving the thyroid, corticotropic, and gonadotropic axes. The prolactin level was elevated. Brain magnetic resonance imaging showed pituitary gland infarction. Desmopressin therapy was initiated and resolved the polyuria. Hormone replacement therapy was administered. Four months later, the patient was well, with partial diabetes insipidus. The literature review indicated that this case was typical in terms of symptoms and disease onset. Most reported cases involve hypotension and peripartum hemorrhage, but some patients without hemorrhage also develop Sheehan's syndrome. Elevated prolactin levels are uncommon and associated with poor prognosis in patients with Sheehan's syndrome.
Acute Sheehan's syndrome with diabetes insipidus involves nearly all pituitary hormone axes, indicating severe disease. Prolactin elevation could suggest that a case of Sheehan's syndrome is severe.
急性席汉氏综合征是一种罕见但潜在危及生命的产科事件，可能并发尿崩症。关于伴有尿崩症的席汉氏综合征的诊断和治疗信息很少。我们报告了一例 28 岁患者，她在分娩后发生急性席汉氏综合征伴尿崩症，并对类似病例进行了系统回顾。
我们使用关键词“席汉氏综合征”或“席汉氏综合征”和“尿崩症”在 PubMed 和 Google Scholar 中进行了系统的文献回顾，以确定 1990 年至 2021 年期间发表的相关病例报告。符合纳入标准的有 8 份报告（可获得英文摘要，发病于产褥期，有发病日期的信息）。
在本病例中，需要进行产后刮宫以清除残留胎盘。总失血量严重（2500 毫升）。产后第二天，患者出现多尿。实验室分析显示高钠血症，血清渗透压升高，尿渗透压降低。激素分析显示甲状腺、促皮质和促性腺轴部分垂体功能减退。催乳素水平升高。脑磁共振成像显示垂体梗死。开始使用去氨加压素治疗，多尿得到缓解。给予激素替代治疗。四个月后，患者病情良好，部分并发尿崩症。文献回顾表明，该病例在症状和发病方面具有典型性。大多数报告的病例涉及低血压和围产期出血，但一些没有出血的患者也会发生席汉氏综合征。催乳素水平升高并不常见，与席汉氏综合征患者的预后不良相关。
伴有尿崩症的急性席汉氏综合征涉及几乎所有垂体激素轴，表明病情严重。催乳素升高可能提示席汉氏综合征严重。
