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1.
BMC Endocr Disord ; 22(1): 24, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-35033053

RESUMO

BACKGROUND: There is only one documented case of intracranial hypertension (IH) and empty sella from cortisol-producing adrenal adenoma so far. And IH and empty sella caused by long-term exogenous hypercortisolism has never been reported before. The purpose of this case report is to alert clinicians to glucocorticoid-induced IH. CASE PRESENTATION: We present retrospectively a 50-year-old woman with cortisol-secreting adrenal adenoma, who progressed to intractable intracranial hypertension and a markedly expanded empty sella due to improper treatment. In 2011, the patient presented with hypertension, lack of cortisol circadian rhythm, low ACTH, a left adrenal adenoma and a partial empty sella, but did not receive low-dose dexamethasone suppression test (LDDST) and 24-h urinary cortisol. In 2014, she exhibited truncal obesity, raised cortisol, LDDST non-suppression, high urinary free cortisol and low ACTH, proving her cortisol-producing adrenal adenoma. She was simultaneously diagnosed with unexplained IH because of papilledema and elevated intracranial pressure, and her partial empty sella changed to a complete empty sella. In 2015, she underwent adrenal adenoma resection. From 2015 to 2018, she kept taking dexamethasone at least 2 mg daily without her doctors' consent. During this period, she developed transient cerebrospinal fluid rhinorrhea, and her empty sella further worsened. After switching to low dose hydrocortisone, her papilledema disappeared completely, but optic atrophy has become irreversible. CONCLUSIONS: The patient seems to be just an extreme case, but it may reveal and illustrate a general phenomenon: Both cortisol-producing adrenal adenoma and long-term exogenous hypercortisolism could cause varying degrees of elevated intracranial pressure and empty sella. Clinicians should remain vigilant for this phenomenon in patients with cortisol-producing adrenal adenoma or excessive and prolonged steroid usage and give them corresponding examinations to identify this complication.


Assuntos
Adenoma Adrenocortical/complicações , Síndrome da Sela Vazia/etiologia , Glucocorticoides/efeitos adversos , Hipertensão Intracraniana/etiologia , Adenoma Adrenocortical/metabolismo , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/metabolismo , Humanos , Pessoa de Meia-Idade
2.
Headache ; 60(10): 2522-2525, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33038281

RESUMO

Primary empty sella (PES) syndrome is a misnomer as it is not a syndrome but a radiological finding with possible endocrine abnormalities. No specific headache type has been shown to be caused by PES. Endocrine screening may be considered for asymptomatic persons with PES.


Assuntos
Síndrome da Sela Vazia/diagnóstico , Síndrome da Sela Vazia/complicações , Síndrome da Sela Vazia/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Enxaqueca sem Aura/diagnóstico , Enxaqueca sem Aura/etiologia , Obesidade/complicações , Vertigem/diagnóstico , Vertigem/etiologia
3.
AJNR Am J Neuroradiol ; 40(10): 1695-1700, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31537518

RESUMO

BACKGROUND AND PURPOSE: Empty sella has been reported in patients with idiopathic intracranial hypertension and is thought to be a sign of elevation of intracranial pressure. However, it can also be found in patients with lateral sinus stenosis presenting with isolated pulsatile tinnitus without signs of intracranial hypertension. We hypothesized that the volume of the sella turcica would be similar in both groups of patients undergoing stent placement for lateral sinus stenosis. MATERIALS AND METHODS: Consecutive patients with idiopathic intracranial hypertension or isolated venous pulsatile tinnitus and undergoing lateral sinus stent placement from January 2012 to December 2017 were included. The primary outcome was the estimated volume of the sella turcica based on preoperative CTA measurements. The ratio of the pituitary gland height/sellar height was calculated on preoperative MR imaging. Sellar volumes were compared among the 3 groups: pulsatile tinnitus, idiopathic intracranial hypertension, and a control group, matched by age and sex. RESULTS: Eighty-eight patients underwent lateral sinus stent placement. The median age was 37 years, and 94% were women. No difference in age, sex, or body mass index was found among the groups. Patients undergoing venous stent placement had significantly higher sellar volumes than the control group (P < 0.001). There was no difference in the sellar volumes (P = .63) or gland/sellar height ratios (P = .25) between the pulsatile tinnitus and idiopathic intracranial hypertension groups. CONCLUSIONS: Empty sella is found in 2 differing groups of patients undergoing lateral sinus stent placement, suggesting that it is a radiologic sign of symptomatic hemodynamic lateral sinus stenosis rather than elevated intracranial pressure.


Assuntos
Síndrome da Sela Vazia/etiologia , Pseudotumor Cerebral/complicações , Zumbido/complicações , Seios Transversos/patologia , Adulto , Idoso , Constrição Patológica/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
Rev Esp Patol ; 52(4): 256-259, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31530410

RESUMO

Ectopic pituitary adenoma is a rare entity that is most commonly located in the sphenoid sinus. We report a case of a patient with ectopic pituitary adenoma with no functional expression associated with empty sella turcica, which gives rise to a broad differential diagnosis. Although it is a benign neoplasm, necrosis is encountered in a proportion of cases. Magnetic resonance imaging is the diagnostic method of choice for hypothalamic-pituitary-related endocrine diseases with endoscopic biopsy for histological confirmation. It is important to include pituitary markers in the immunohistochemical diagnostic panel.


Assuntos
Adenoma/diagnóstico por imagem , Coristoma/diagnóstico por imagem , Síndrome da Sela Vazia/etiologia , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Seio Esfenoidal/diagnóstico por imagem , Adenoma/química , Adenoma/patologia , Adenoma/cirurgia , Adulto , Biomarcadores Tumorais/análise , Coristoma/metabolismo , Coristoma/patologia , Coristoma/cirurgia , Diagnóstico Diferencial , Erros de Diagnóstico , Síndrome da Sela Vazia/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Proteínas de Neoplasias/análise , Tumores Neuroendócrinos/diagnóstico , Osteólise/etiologia , Neoplasias dos Seios Paranasais/química , Neoplasias dos Seios Paranasais/patologia , Neoplasias dos Seios Paranasais/cirurgia , Hormônios Adeno-Hipofisários/análise , Neoplasias Hipofisárias/química , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Seio Esfenoidal/química , Seio Esfenoidal/patologia , Seio Esfenoidal/cirurgia
5.
BMJ Case Rep ; 12(3)2019 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-30850565

RESUMO

We describe the clinical course of a 64-year-old woman with stage IVa lung adenocarcinoma who presented with over 1 month of fatigue, unintentional weight loss and emesis. She initiated treatment with nivolumab immunotherapy 1 year prior and had been tolerating the treatment well. A comprehensive workup revealed multiple endocrinological abnormalities consistent with hypophysitis leading to hypopituitarism in the form of central adrenal insufficiency and hypogonadism as well as a partially empty sella on imaging. This case demonstrates that while receiving novel forms of treatment such as immunotherapy, patients should be monitored closely for a wide range of adverse effects.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/complicações , Hipofisite/induzido quimicamente , Nivolumabe/efeitos adversos , Adenocarcinoma de Pulmão/patologia , Insuficiência Adrenal/complicações , Anti-Inflamatórios/uso terapêutico , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Síndrome da Sela Vazia/diagnóstico por imagem , Síndrome da Sela Vazia/etiologia , Feminino , Humanos , Hidrocortisona/administração & dosagem , Hidrocortisona/uso terapêutico , Hipofisite/complicações , Hipopituitarismo/tratamento farmacológico , Hipopituitarismo/etiologia , Neoplasias Pulmonares/patologia , Pessoa de Meia-Idade , Nivolumabe/uso terapêutico , Resultado do Tratamento
6.
World Neurosurg ; 121: 145-148, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30315973

RESUMO

BACKGROUND: Visual field deterioration caused by secondary empty sella after cabergoline therapy for prolactinoma is a rare event. Chiasmapexy is performed to treat empty sella syndrome. Although various materials have been used for the elevation of the optic chasm, the most appropriate material remains to be established. Here, we describe the efficiency of chiasmapexy for empty sella syndrome following dopamine agonist treatment and the utility of septal cartilage and sphenoidal sinus bone as materials for chiasmapexy. CASE DESCRIPTION: A 35-year-old male with a history of cabergoline therapy for prolactinoma presented with visual deterioration. His magnetic resonance imaging revealed optic chiasm herniation into the empty sella. Endoscopic endonasal transsphenoidal chiasmapexy was performed using septal cartilage and sphenoidal sinus bone as materials for elevating the chiasm. Visual function improved immediately after operation. CONCLUSIONS: Chiasmapexy is an effective surgical method for treating visual deterioration caused by empty sella after cabergoline treatment. Endoscopic endonasal chiasmapexy with septal cartilage and sphenoidal sinus bone is a considerable option because it is minimally invasive and involves decreased risk of infection.


Assuntos
Transplante Ósseo , Cartilagem/transplante , Síndrome da Sela Vazia/cirurgia , Cirurgia Endoscópica por Orifício Natural , Prolactinoma/tratamento farmacológico , Adulto , Cabergolina/efeitos adversos , Cabergolina/uso terapêutico , Agonistas de Dopamina/efeitos adversos , Agonistas de Dopamina/uso terapêutico , Síndrome da Sela Vazia/diagnóstico por imagem , Síndrome da Sela Vazia/etiologia , Humanos , Masculino , Prolactinoma/complicações , Prolactinoma/diagnóstico por imagem , Transplante Autólogo , Transtornos da Visão/diagnóstico por imagem , Transtornos da Visão/etiologia , Transtornos da Visão/cirurgia
7.
Rom J Morphol Embryol ; 59(1): 381-384, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29940653

RESUMO

Empty sella means the absence of the pituitary gland on cranial computed tomography or magnetic resonance imaging. Empty sella syndrome is the pathological variant of the imaging-described empty sella. We present the case of a male Caucasian child, aged four years and two months, for short stature and diagnosed by imaging procedures as empty sella. The cause of short stature was isolated growth hormone (GH) deficiency. Associated he presented left hand postaxial polydactyly. In connection with this particular case, we propose a review of current knowledge in empty sella syndrome. The particularity of reported case consists of association empty sella with GH deficiency and polydactyly. The association of empty sella with polydactyly is not reported yet in the medical literature and is probably coincidental.


Assuntos
Síndrome da Sela Vazia/etiologia , Hormônio do Crescimento/deficiência , Polidactilia/etiologia , Pré-Escolar , Síndrome da Sela Vazia/patologia , Humanos , Masculino , Polidactilia/patologia
8.
Childs Nerv Syst ; 33(2): 385-387, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27757566

RESUMO

BACKGROUND: Tectal gliomas (TG) are slow-growing tumors and generally present with features of increased intracranial pressure. CASE DESCRIPTION: We describe an unusual case of a young girl who presented with clinical triad of obesity, primary amenorrhea and central cord syndrome. The radiology unveiled a pentad of hydrocephalus, empty sella, suprapineal recess diverticulum, secondary Chiari malformation and cervical syringomyelia, masking a relatively obscure tectal plate glioma. She was subjected to endoscopic third ventriculostomy (ETV). All of her symptoms improved after ETV and the tumor is being followed up. The possible pathogenesis of such a highly atypical clinico-radiological presentation is described. CONCLUSION: This unusual syndromic presentation of tectal glioma without clinical features of increased intracranial pressure is probably due to increased compliance of third ventricular walls, and is relieved with ETV.


Assuntos
Amenorreia/etiologia , Neoplasias do Tronco Encefálico/complicações , Neoplasias do Tronco Encefálico/cirurgia , Glioma/complicações , Hidrocefalia/etiologia , Obesidade/etiologia , Ventriculostomia/métodos , Adolescente , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Síndrome Medular Central/etiologia , Síndrome da Sela Vazia/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética
10.
Ger Med Sci ; 14: Doc07, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27408609

RESUMO

OBJECTIVES: Sellar reconstruction with intrasellar packing following endoscopic resection of pituitary macroadenomas remains a subject of clinical and radiological discussion particularly, when an intraoperative cerebrospinal fluid (CSF) leakage is absent. This study was conducted to contribute our experience with sellar reconstruction after a standard endoscopic surgery of pituitary macroadenomas without intraoperative CSF leakage to the ongoing discussion between techniques with and without intrasellar packing. METHODS: A consecutive series of 47 pituitary macroadenomas undergoing excision via a standard endoscopic endonasal transsphenoidal surgery (EETS) without evident intraoperative CSF leakage were retrospectively evaluated over a 10-months mean follow-up period. According to the sellar reconstruction technique, three groups could be identified: Group A - with no intrasellar packing, Group B - with haemostatic materials packing, and Group C - with abdominal fat packing. Postoperative clinical and radiological assessments of the three groups were documented and analyzed for differences in outcome. RESULTS: Postoperative clinical assessment did not differ significantly between the three groups. In group A, postoperative CSF leakage, sphenoid sinusitis and empty sella syndrome were not observed. However, a significant difference in radiological assessment could be identified; the interpretation of sellar contents in postoperative MRI of group A succeeded earlier and more reliably than in other groups with intrasellar packing. CONCLUSIONS: There is no difference in the incidence of postoperative CSF leakage and empty sella syndrome among the various reconstructive techniques with and without intrasellar packing, irrespective of size and extension of the pituitary adenoma. Sellar reconstruction without intrasellar packing following a standard EETS is not inferior to other techniques with packing and even shows more radiological advantages, which made it our preferred technique, at least if no intraoperative CSF leakage is evident.


Assuntos
Adenoma/cirurgia , Neoplasias Hipofisárias/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias/etiologia , Sela Túrcica/cirurgia , Gordura Abdominal/transplante , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vazamento de Líquido Cefalorraquidiano/etiologia , Síndrome da Sela Vazia/diagnóstico por imagem , Síndrome da Sela Vazia/etiologia , Endoscopia , Feminino , Hemostase Endoscópica/métodos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Procedimentos de Cirurgia Plástica/efeitos adversos , Estudos Retrospectivos , Sela Túrcica/diagnóstico por imagem , Sinusite Esfenoidal/etiologia , Adulto Jovem
11.
Pediatrics ; 137(5)2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27244801

RESUMO

Newborn screening has dramatically reduced rates of untreated congenital hypothyroidism (CH). However, in low-income nations where newborn screening programs do not exist, untreated CH remains a significant health and societal challenge. The goal of this report is to alert health care providers about the potential of undiagnosed CH in unscreened immigrant children. We report 3 siblings of Somali descent with CH who started treatment with levothyroxine at age 0.5 years, 7.7 years, and 14.8 years and were followed for 8 years. This case series demonstrates a spectrum of severity, response to treatment, and neurocognitive and growth outcomes depending on the age at treatment initiation. Patient 1, now 22 years old, went undiagnosed for 14.8 years. On diagnosis, his height was -7.5 SDs with a very delayed bone age of -13.5 SDs. His longstanding CH was associated with empty sella syndrome, static encephalopathy, and severe musculoskeletal deformities. Even after treatment, his height (-5.2 SDs) and cognitive deficits remained the most severe of the 3 siblings. Patient 2, diagnosed at 7.7 years, had moderate CH manifestations and thus a relatively intermediate outcome after treatment. Patient 3, who had the earliest diagnosis at 0.5 years, displayed the best response, but continues to have residual global developmental delay. In conclusion, untreated CH remains an important diagnostic consideration among immigrant children.


Assuntos
Hipotireoidismo Congênito/diagnóstico , Hipotireoidismo Congênito/tratamento farmacológico , Emigrantes e Imigrantes , Tiroxina/uso terapêutico , Adolescente , Encefalopatias/etiologia , Criança , Transtornos Cognitivos/etiologia , Hipotireoidismo Congênito/complicações , Diagnóstico Tardio , Síndrome da Sela Vazia/etiologia , Seguimentos , Transtornos do Crescimento/etiologia , Humanos , Lactente , Deformidades Congênitas das Extremidades Inferiores/etiologia , Masculino , Linhagem , Somália
12.
J Neurosurg ; 124(4): 1025-31, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26339851

RESUMO

Visual deterioration after dopamine-agonist treatment of prolactinomas associated with empty sella syndrome and secondary optic apparatus traction is a rare event. Chiasmapexy has been described as a viable treatment option, although few cases exist in the literature. Here, a novel endonasal endoscopic approach to chiasmapexy is described and its efficacy is demonstrated in a case report. A 55-year-old female patient with a history of a giant prolactinoma and 14 years of treatment using dopaminergic agonist therapy presented to our institution with a 1-month history of visual changes. Neuroophthalmological examination confirmed severe bitemporal field defects, and MRI revealed a large empty sella with downward optic chiasmal herniation. Endoscopic endonasal chiasmapexy was performed by elevating the chiasm with lumbar drainage and filling the clival and sellar defect with an extradural liquid (HydroSet; a cranioplasty bone cement), and a piece of AlloDerm was used to cover and cushion the chiasm. Postoperative imaging demonstrated successful anatomical elevation of the optic apparatus, and the patient showed functional improvement in the visual field at 3 months postoperatively. Although rare, massive empty sellar and chiasmal descent from macroadenoma treatment can result in progressive visual loss. Here, a novel technique of endonasal endoscopic extradural cranioplasty aided by lumbar drainage is reported, which appears to be an effective technique for stabilizing and possibly reversing anatomical and visual deterioration.


Assuntos
Craniotomia/métodos , Síndrome da Sela Vazia/cirurgia , Endoscopia/métodos , Cavidade Nasal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Quiasma Óptico/cirurgia , Neoplasias Hipofisárias/complicações , Prolactinoma/complicações , Osso Esfenoide/cirurgia , Transtornos da Visão/etiologia , Transtornos da Visão/cirurgia , Bromocriptina/uso terapêutico , Síndrome da Sela Vazia/etiologia , Feminino , Antagonistas de Hormônios/uso terapêutico , Humanos , Pessoa de Meia-Idade , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Base do Crânio/anatomia & histologia , Base do Crânio/cirurgia , Resultado do Tratamento
13.
Endocrine ; 50(2): 483-8, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25896551

RESUMO

Endocrine abnormalities are known to affect patients with Fabry disease (FD). Pituitary gland theoretically represents an ideal target for FD because of high vascularization and low proliferation rate. We explored pituitary morphology and function in a cohort of FD patients through a prospectic, monocentric study at an Academic Tertiary Center. The study population included 28 FD patients and 42 sex and age-matched normal subjects. The protocol included a contrast enhancement pituitary MRI, the assessment of pituitary hormones, anti-pituitary, and anti-hypothalamus antibodies. At pituitary MRI, an empty sella was found in 11 (39%) FD patients, and in 2 (5%) controls (p < 0.001). Pituitary volume was significantly smaller in FD than in controls (p < 0.001). Determinants of pituitary volume were age and alpha-galactosidase enzyme activity. Both parameters resulted independently correlated at multivariate analysis. Pituitary function was substantially preserved in FD patients. Empty sella is a common finding in patients with FD. The major prevalence in the elderly supports the hypothesis of a progressive pituitary shrinkage overtime. Pituitary function seems not to be impaired in FD. An endocrine workup with pituitary hormone assessment should be periodically performed in FD patients, who are already at risk of cardiovascular complications.


Assuntos
Síndrome da Sela Vazia/etiologia , Doença de Fabry/complicações , Doenças da Hipófise , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças da Hipófise/etiologia , Doenças da Hipófise/metabolismo , Doenças da Hipófise/patologia
15.
J Pediatr Endocrinol Metab ; 27(9-10): 939-46, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24859515

RESUMO

Pituitary infarction or apoplexy with spontaneous cure of the underlying pituitary adenoma is rare. In the paediatric population, we found only a few reported cases. We report a rare case of pituitary infarction progressing to CSF-sella syndrome (or empty sella) in an 11-year-old girl. She presented with sudden onset vomiting, moderate headaches, lethargy, weight loss, and tall stature above her mid-parental height. She did not have any severe symptoms of apoplexy. Her clinical and radiological findings suggested infarction of a pituitary lesion, such as a pituitary adenoma or infarction of a cystic lesion, such as a Rathke's cleft cyst. In this report, we discuss her case of probable infarction of a growth hormone secreting adenoma with a phase of accelerated growth ending up with total anterior pituitary insufficiency. The differential diagnosis and review of the rare cases of paediatric pituitary infarction in the literature will be discussed.


Assuntos
Infarto Encefálico/complicações , Síndrome da Sela Vazia/etiologia , Apoplexia Hipofisária/complicações , Neoplasias Hipofisárias/complicações , Criança , Síndrome da Sela Vazia/patologia , Feminino , Humanos , Apoplexia Hipofisária/patologia , Neoplasias Hipofisárias/patologia , Remissão Espontânea
16.
Clin Neuropathol ; 33(3): 197-202, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24447694

RESUMO

Ectopic pituitary adenomas are uncommon entities that may pose substantial diagnostic challenges. In the majority of these cases, patients present with endocrine and/or nasal obstruction symptoms. We report the case of an ectopic pituitary adenoma in a 76-year-old man with an empty sella who initially presented with right-sided hearing loss progressing to bilateral hearing loss over the next 4 years. Neuroimaging studies revealed a large, expansile central skull base mass replacing the clivus and sphenoid sinus, and invading the internal auditory canals and inner ear bilaterally. The tumor also involved the floor of the middle cranial fossae and bilateral medial temporal and occipital bones. Histopathologic examination, including immunohistochemical studies, revealed a sparsely granulated lactotroph adenoma. Hearing loss in a patient with ectopic pituitary adenoma constitutes an extremely unusual presentation. This case was further complicated by the presence of an empty sella and the absence of symptoms related to hyperprolactinemia.


Assuntos
Adenoma/complicações , Coristoma/complicações , Síndrome da Sela Vazia/etiologia , Perda Auditiva Unilateral/etiologia , Neoplasias Hipofisárias/complicações , Adenoma/patologia , Idoso , Coristoma/patologia , Síndrome da Sela Vazia/patologia , Perda Auditiva Unilateral/patologia , Humanos , Masculino , Neoplasias Hipofisárias/patologia
17.
J Obstet Gynaecol Res ; 40(1): 46-52, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23945005

RESUMO

AIM: To evaluate factors related to the occurrence of Sheehan syndrome. METHODS: The obstetrical disseminated intravascular coagulation score, total volume of hemorrhage, shock index, level of consciousness at the time of shock occurrence and pituitary magnetic resonance imaging findings were evaluated in nine women who showed massive hemorrhage during delivery. These clinical outcomes were analyzed in all these patients who were prospectively followed-up to identify any possible occurrence of Sheehan syndrome. RESULTS: Compared to six women with non-Sheehan syndrome, three women who were diagnosed with Sheehan syndrome showed significant elevation of the obstetrical disseminated intravascular coagulation score, decrease in the level of consciousness during shock and remarkable pituitary gland atrophic change with an empty sella turcica detected by pituitary magnetic resonance imaging. The volume of hemorrhage during delivery and shock index were not significantly different between these two groups of women. CONCLUSION: Careful attention and follow-up should be paid to women with post-partum massive hemorrhage for early detection and management of women with Sheehan syndrome.


Assuntos
Cesárea/efeitos adversos , Hipopituitarismo/etiologia , Hemorragia Pós-Operatória/fisiopatologia , Hemorragia Pós-Parto/fisiopatologia , Choque Hemorrágico/fisiopatologia , Descolamento Prematuro da Placenta/fisiopatologia , Adulto , Atrofia , Recesariana/efeitos adversos , Coagulação Intravascular Disseminada/etiologia , Coagulação Intravascular Disseminada/prevenção & controle , Síndrome da Sela Vazia/etiologia , Feminino , Seguimentos , Humanos , Hipopituitarismo/patologia , Hipopituitarismo/fisiopatologia , Histerectomia , Imageamento por Ressonância Magnética , Hipófise/patologia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/cirurgia , Hemorragia Pós-Operatória/terapia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/cirurgia , Hemorragia Pós-Parto/terapia , Gravidez , Índice de Gravidade de Doença , Choque Hemorrágico/etiologia , Choque Hemorrágico/prevenção & controle , Estupor/etiologia , Estupor/prevenção & controle
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