Assessment of bleeding disorders in Sheehan's syndrome: Are bleeding disorders the underlying cause of Sheehan's syndrome?

Department of Endocrinology, Faculty of Medicine, Dicle University School of Medicine, Diyarbakir, Turkey.
Platelets (Impact Factor: 2.98). 03/2011; 22(2):92-7. DOI: 10.3109/09537104.2010.525722
Source: PubMed


Sheehan's syndrome (SS) is an adenopituitary insufficiency caused by hypovolemia secondary to excessive blood loss during or after childbirth. However, the mechanism of postpartum hemorrhage and ischemia is not clear. We aimed to evaluate the bleeding disorders among patients with SS, in comparison with healthy controls. In addition, we investigated underlying causes in postpartum hemorrhage that begin the event. The present study was conducted at the Dicle University School of Medicine. Forty-eight patients with SS and 50 age-matched female healthy controls were included. Biochemical and hormonal variables were measured, as was platelet function by means of closure times (PFA-100 testing using collagen plus epinephrine and collagen plus ADP), von Willebrand factor (vWF) level, prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), and coagulation factors. Although PT and INR were significantly higher in patients with SS (both P<0.01), aPTT and levels of fibrinogen, vWF, and factors II, V, VII, VIII, IX, X, XI, and XII did not differ significantly. Closure times with collagen/epinephrine and collagen/ADP also did not differ significantly between patients with SS and control patients. The nonspecific etiology and presence of excessive postpartum hemorrhage in patients with SS suggest that coagulation disorders may play a role in their predisposition to bleeding. The increased PT and INR noted might implicate bleeding diathesis as the underlying etiology, although no significant decreases were noted in factor levels. Further studies are needed to elucidate this complex mechanism of this disorder.

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    ABSTRACT: Le syndrome de Sheehan (SS) est une complication potentiellement grave du post-partum qui correspond à une nécrose ischémique de l’antéhypophyse en rapport avec une hémorragie de la délivrance, il reste d’actualité malgré l’amélioration de la prise en charge gynéco-obstétricale. Le diagnostic qui n’est habituellement porté que plusieurs années après l’événement obstétrical, par la présence de signes d’insuffisance antéhypophysaire, peut toutefois être précoce en post-partum immédiat et emprunter des formes aiguës graves qui sont de véritables urgences métaboliques et endocriniennes. Cet article a pour objectif de sensibiliser le clinicien aux différentes situations inhabituelles graves pouvant révéler le SS dans les suites précoces d’un accouchement hémorragique afin de porter en urgence le diagnostic et de démarrer une prise en charge spécifique.
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    ABSTRACT: Abstract Sheehan's syndrome (SS) is characterized by various degrees of hypopituitarism, and develops as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. Increased pituitary volume, small sella size, disseminated intravascular coagulation and autoimmunity are the proposed factors in the pathogenesis of SS. Hormonal insufficiencies, ranging from single pituitary hormone insufficiency to total hypopituitarism, are observed in patients. The first most important issue in the diagnosis is being aware of the syndrome. Lack of lactation and failure of menstrual resumption after delivery that complicated with severe hemorrhage are the most important clues in diagnosing SS. The most frequent endocrine disorders are the deficiencies of growth hormone and prolactin. In patients with typical obstetric history, prolactin response to TRH seems to be the most sensitive screening test in diagnosing SS. Other than typical pituitary deficiency, symptoms such as anemia, pancytopenia, osteoporosis, impairment in cognitive functions and impairment in the quality of life are also present in these patients. Treatment of SS is based on the appropriate replacement of deficient hormones. Growth hormone replacement has been found to have positive effects; however, risk to benefit ratio, side effects and cost of the treatment should be taken into account.
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