Minamoto Yuki, Sasai Yumiko, Yamashita Yui, Yamagami Keiko, Fujisawa Ichiro, Kanamoto Naotetsu
Department of Endocrinology, Osaka City General Hospital, Osaka 534-0021, Japan.
Department of Radiology, Kishiwada City Hospital, Osaka 596-8501, Japan.
JCEM Case Rep. 2025 Jul 11;3(8):luaf134. doi: 10.1210/jcemcr/luaf134. eCollection 2025 Aug.
Acute Sheehan syndrome is a rare condition that occurs hours to days post partum and causes hypopituitarism. It may cause hyponatremia due to adrenal insufficiency, and most patients improve with steroid therapy. However, hyponatremia is caused not only by adrenal insufficiency but also by inappropriate secretion of arginine vasopressin (AVP). We report the case of a 30-year-old Japanese primipara with massive postpartum hemorrhage and acute Sheehan syndrome. Hyponatremia developed following hypernatremia soon after the postpartum period; however, it did not improve despite adequate hydrocortisone supplementation. AVP fluctuated based on water balance and magnetic resonance imaging findings, showing distinctive AVP secretion dynamics. Oral 1-desamino-8-D-arginine vasopressin was temporarily needed during the clinical course, after which it was not needed, suggesting that impaired blood flow to the posterior pituitary lobe and its improvement may have contributed to the distinctive AVP secretion dynamics. Therefore, when hyponatremia is not improved despite adequate hydrocortisone supplementation in patients with acute Sheehan syndrome, the syndrome of inappropriate antidiuretic hormone secretion should be considered because distinctive AVP secretion dynamics can occur after severe ischemia of the pituitary gland.
急性希恩综合征是一种罕见病症，发生于产后数小时至数天，可导致垂体功能减退。它可能因肾上腺功能不全引起低钠血症，大多数患者经类固醇治疗后病情改善。然而，低钠血症不仅由肾上腺功能不全引起，还由精氨酸加压素（AVP）分泌不当所致。我们报告一例30岁日本初产妇，发生大量产后出血及急性希恩综合征。产后不久高钠血症后出现低钠血症；然而，尽管补充了足够的氢化可的松，低钠血症仍未改善。AVP根据水平衡和磁共振成像结果波动，显示出独特的AVP分泌动态。临床过程中曾临时需要口服1-去氨基-8-D-精氨酸加压素，之后不再需要，这表明垂体后叶血流受损及其改善可能导致了独特的AVP分泌动态。因此，急性希恩综合征患者在补充足够氢化可的松后低钠血症仍未改善时，应考虑抗利尿激素分泌不当综合征，因为垂体严重缺血后可能会出现独特的AVP分泌动态。
