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Archives of Gynecology and Obstetrics
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Archives of Gynecology and Obstetrics
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https://dx.doi.org/10.22028/d2...
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Acute Sheehan’s syndrome manifesting initially with diabetes insipidus postpartum: a case report and systematic literature review

Authors: Olmes, Gregor Leonhard; Solomayer, Erich-Franz; Radosa, Julia Caroline; Sklavounos, Panagiotis; Agne, Philipp; Schunk, Stefan J.; Haj Hamoud, Bashar;

Acute Sheehan’s syndrome manifesting initially with diabetes insipidus postpartum: a case report and systematic literature review

Abstract

Abstract Purpose 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. Methods 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). Results 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. Conclusion 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.

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Keywords

Adult, ddc:610, Polyuria, Postpartum Hemorrhage, Postpartum Period, Peripartum hemorrhage, 610, Diabetes insipidus, Female [MeSH] ; Prolactin ; Sheehan’s syndrome ; Prolactin [MeSH] ; Adult [MeSH] ; Postpartum Hemorrhage/diagnosis [MeSH] ; Humans [MeSH] ; Postpartum Hemorrhage/therapy [MeSH] ; Polyuria/complications [MeSH] ; Case report ; Hypopituitarism/complications [MeSH] ; Peripartum hemorrhage ; Postpartum Period [MeSH] ; Diabetes Mellitus [MeSH] ; Hypopituitarism/diagnosis [MeSH] ; Maternal-Fetal Medicine ; Postpartum Hemorrhage/etiology [MeSH] ; Diabetes insipidus ; Pregnancy [MeSH], Hypopituitarism, Maternal-Fetal Medicine, Prolactin, Sheehan���s syndrome, Pregnancy, Case report, Diabetes Mellitus, Humans, Sheehan’s syndrome, Female

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
13
Top 10%
Top 10%
Top 10%
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