RESUMEN
Nineteen patients with a diagnosis of Sheehan's syndrome or postpartum hypopituitarism admitted to the UP-PGH Medical Center from 1974-1984 were reviewed. The history, signs and symptoms, and results of various laboratory examinations were assessed. Two patients had available postmortem reports Panhypopituitarism (89%) was more common than selective hypopituitarism. LSH producing cells seemed to be spared more often than the others. Hypothyroidism was seen in only 89% of the cases as compared to gonadal failure (100%), and cortisol insufficiency (100%). The pituitary involvement was not limited to the anterior pituitary but may involve the posterior pituitary and or the hypothalamus as suggested by the coexistence of manifestations of diabetes insipidus in 2 of our patients Most common cause of postpartum pituitary necrosis was obstetric hemorrhage but it could also be produced by any condition resulting in severe shock. The syndrome was usually heralded by failure of lactation and amenorrhea associated later with loss of axillary and public hair; genital, uterine, and breast atrophy; symptoms and signs of hypothyroidism and various degrees of adrenocortical insufficiency The different tests designed to show target organ failure did not show positivity in all patients. Among the tests which showed consistent results and thus were most helpful for diagnosis were determinations of: FSH, cortisol and T4 There is excellent prognosis for a productive life of patients with replacement of all target gland hormonal deficiencies. However, failure to diagnose it is disastrous for the patients. Continuation of treatment especially in the presence of stress, i.e. infection should be emphasized by the physicians. Regular follow-up at intervals of all patients with Sheehan's syndrome is necessarily recommended, (Summary)
RESUMEN
Fifteen diabetic patients were maintained on a random sequence of control and experimental diets for a period of 12 weeks each. These diets were identical except for crude fiber content, the control diet containing an additional 8g/r day in the form of rice ground bran or "darak". Three patients dropped out of study, two during the control phase, and one during the experimental phase. Using uniform criteria for dosage adjustment among the 12 who finish the study, there was the mean dropped of 69% in dose of current medications during the experimental phase (p0.01). Only two patients had an increase in medications during the experimental phase. One had very poor medical compliance, while in the other, the drop in the medications seems to have heralded the onset of diabetic nephropathy. There was no significant change in serum cholesterol, triglycerides, uric acid, creatinine, calcium, phosphate, sodium, potassium, and chloride, but sample size may have been too small to detect these. The experimental diet was generally well tolerated in terms of texture, appearance, and flavor but nine patients complained of slightly bitter after taste. At the end of study however, pastries and bread were baked with the "darak" and were considered very acceptable by all patients. Average cost of supplementaion per meal was 20 centavos. We conclude that "darak" is a cheap, acceptable, and safe source of dietary fiber, which may be an effective adjustment in the outpatient control diabetic hyperglycemia. (Author)