Clinical study of Sheehan's syndrome in Thailand

Thirteen patients who were admitted to the hospital between 1964 and 1969 and in whom clinical and laboratory data had established a diagnosis of postpartum pituitary necrosis are reviewed. Eight of them had a history of either shock or unconsciousness during intrapartum or postpartum hemorrhage. The diagnosis was made 10mth to 13yr after the episode of bleeding. The early noticeable symptoms were decreased lactation, weakness, easy fatigability, amenorrhoea, dry skin and cold intolerance. Interestingly enough four cases came with hypoglycemic episodes and two had hyperpigmentation of skin. The most common findings were loss of pubic and axillary hair, vaginal atrophy, dry skin, prolonged deep tendon reflexes and slow pulse. The urinary gonadotropin levels were less than six mouse units per 24 hr in all but one case. All cases had hypothyroidism. The basal metabolic rate values corresponded more with the clinical state than radioactive iodine uptake. In 12 cases of adrenal cortical insufficiency, the findings were supported by laboratory tests. Metopirone tests were performed in three cases, which proved them to have definitely poor pituitary reserve. None had diabetes insipidus. These findings showed that patients with severe anterior pituitary deficiency show functional impairment of the secondary organs in the sequence: gonads, thyroid and adrenal cortex.