ABSTRACT
We investigated the factors associated with serum muscle enzyme elevation in patients with Sheehan's syndrome. A total of 48 patients who were newly diagnosed with Sheehan's syndrome were included and divided into 3 groups: Group 1, creatine kinase (CK)â ≥â 1000 U/L; Group 2, 140â <â CKâ <â 1000 U/L; and Group 3, CKâ ≤â 140 U/L. Differences in serum muscle enzymes, serum electrolytes, blood glucose and hormones were compared among the 3 groups. A Spearman correlation analysis and multiple linear regression analysis were performed on serum muscle enzymes and the other variables. Four patients in Group 1 underwent electromyography. Fourteen, 26 and 8 patients were divided into Group 1, Group 2, and Group 3, respectively. The levels of plasma osmolality, serum sodium, free triiodothyronine (FT3) and free thyroxine (FT4) in Group 1 were lower than those in Group 3 at admission (Pâ <â .05). There were significant differences in CK, CK-MB, aspartate aminotransferase, lactate dehydrogenase, and alpha-hydroxybutyrate dehydrogenase among the three groups (Pâ <â .05). CK was correlated with serum sodium (râ =â -0.642, Pâ <â .001), serum potassium (râ =â -0.29, Pâ =â .046), plasma osmolality (râ =â -0.65, Pâ <â .001), FT3 (râ =â -0.363, Pâ =â .012), and FT4 (râ =â -0.450, Pâ =â .002). Moreover, creatine kinase isoenzyme-MB (CK-MB) was correlated with serum sodium (râ =â -0.464, Pâ =â .001) and plasma osmolality (râ =â -0.483, Pâ <â .001). The multiple linear regression showed that serum sodium was independently and negatively correlated with CK (râ =â -0.352, Pâ =â .021). The electromyogram results supported the existence of myogenic injury. Sheehan's syndrome is prone to be complicated by nontraumatic rhabdomyolysis, with both a chronic course and acute exacerbation. Serum muscle enzymes should be routinely measured. For patients with CK levelsâ >â 1000 U/L, a CK-MB/CK ratioâ <â 6% can be a simple indicator to differentiate rhabdomyolysis from acute myocardial infarction. Abnormal serum muscle enzymes observed in Sheehan's syndrome may be associated with hypothyroidism and with hyponatremia in particular.
Subject(s)
Hypopituitarism , Rhabdomyolysis , Aspartate Aminotransferases , Blood Glucose , Creatine Kinase , Electrolytes , Humans , Hypopituitarism/complications , Isoenzymes , L-Lactate Dehydrogenase , Muscles , Potassium , Rhabdomyolysis/complications , Sodium , Thyroxine , TriiodothyronineABSTRACT
This review aimed to evaluate the level of fatigue in adults with type 2 diabetes measured by the validated Diabetes Symptom Checklist (DSC)and related factors. Ten studies were included. Both DSC (n = 4) and the revised (n = 6) have been used to measure fatigue. When the latter was used (n = 1082), the pooled level of fatigue was 1.77 (on a 0-5 scale). When the former was used (n = 674), the pooled level of fatigue was 1.73 (on a 0-10 scale). Participant demographics (e.g., gender), health information (e.g., BMI), and diabetes-specific factors (e.g., A1C and diabetes distress) were associated with fatigue. Fatigue was negatively related to self-care behaviors. The prevalence of significant fatigue remains unclear due to a lack of a cut-off point of the instrument. Future research is warranted to identify the threshold for clinically significant fatigue and investigate the causal relationship. Nurses are recommended to perform a routine assessment of fatigue.