Since the original recognition by Simmonds of the clinical and pathologic syndrome caused by destruction of the anterior lobe of the pituitary gland, it has been known that the disease most commonly begins following complications of pregnancy.
Clinical panhypopituitarism, long known as Simmonds´ disease, may be brought about, by a variety, of pathological lesions, such as an ischemic necrosis following postpartum hemorrhage or abnormal delivery, tumors, granulomas, injury; surgical hypospontaneous atrophy and fibrosis. Of them postpartum hemorrhage or abnormal delivery is by far the commonest cause of Simmond´s disease.
The purpose of this report is to review the clinical and laboratory findings of twelve cases of Sheehan´s syndrome observed at the Catholic Medical College Hospital duringthe past five years.
All patients had a typical history of difficult or complicated labor : thereafter they began to notice various symptoms and signs such as asthenia, anorexia, pallor, loss of axillary and pubic hair, breast atrophy, indigestion, puffiness, dryness of skin, loss of libido, amenorrhea, cold intolerance, headache and nervous irritability. Laboratory data revealed a moderate normocytic and normochromic anemia, reduced basal metabolic rate, low thyroidal ^(131)I uptake, usually lowered excretion of urinary 17 ketosteroids and urinary gonadotropin, tendency to lowered fasting blood sugar and flat glucose tolecurve and positive water loading test.
In all of the patients treatment consisted of cortisone acetate, desiccated thyroid and stilbesterol.
In as much as home delivery is practiced in many of rural areas in Korea leading to higher incidence of postpartum complications, high index of suspicion is essential in early detection of the disease.
|