Table of Contents Author Guidelines Submit a Manuscript
International Journal of Endocrinology
Volume 2018, Article ID 8415860, 8 pages
https://doi.org/10.1155/2018/8415860
Research Article

Sheehan’s Syndrome Revisited: Underlying Autoimmunity or Hypoperfusion?

1Endocrinology Division, Department of Internal Medicine, University Hospital “Dr. José E. González”, Universidad Autonoma de Nuevo Leon, 64460 Monterrey, NL, Mexico
2Research Unit, University Hospital “Dr. José E. González”, Universidad Autonoma de Nuevo León, 64460 Monterrey, NL, Mexico
3Gastroenterology Division, University Hospital “Dr. José E. González”, Universidad Autonoma de Nuevo León, 64460 Monterrey, NL, Mexico
4Gynecology and Obstetrics Division, University Hospital “Dr. José E. González”, Universidad Autonoma de Nuevo Leon, 64460 Monterrey, NL, Mexico
5Histology Department, Facultad de Medicina, Universidad Autonoma de Nuevo Leon, 64460 Monterrey, NL, Mexico
6Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN 55905, USA
7Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA

Correspondence should be addressed to René Rodríguez-Gutiérrez; ude.oyam@ener.zerreitugzeugirdor

Received 20 September 2017; Revised 2 January 2018; Accepted 8 January 2018; Published 26 February 2018

Academic Editor: Jack Wall

Copyright © 2018 José Gerardo González-González et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Sheehan’s syndrome remains a frequent obstetric complication with an uncertain pathophysiology. We aimed to assess the incidence of hypopituitarism (≥2 hormonal axis impairment) within the first six postchildbirth months and to determine the existence of anti-pituitary antibodies. From 2015 to 2017, adult pregnant women, who developed moderate to severe postpartum hemorrhage (PPH), were consecutively included in the study. Pituitary function was assessed 4 and 24 weeks after PPH. At the end of the study, anti-pituitary antibodies were assessed. Twenty women completed the study. Mean age was 26.35 (±5.83) years. The main etiology for severe PPH was uterine atony (65%) which resulted mostly in hypovolemic shock grades III-IV. Within the first four weeks after delivery, 95% of patients had at least one hormonal pituitary affected and 60% of the patients fulfilled diagnostic criteria for hypopituitarism. At the end of the study period, five patients (25%) were diagnosed with hypopituitarism (GH and cortisol axes affected). Anti-pituitary antibodies were negative in all patients. At 6 months follow-up, one in every four women with a history of moderate-to-severe PPH was found with asymptomatic nonautoimmune-mediated hypopituitarism. The role of autoimmunity in Sheehan’s syndrome remains uncertain. Further studies are needed to improve the remaining knowledge gaps.