J Korean Soc Endocrinol.  2006 Aug;21(4):333-337. 10.3803/jkes.2006.21.4.333.

A Case of Sheehan's Syndrome Presenting Central Diabetes Insipidus

• Kim DJ
• Kim NH
• Park JR
• Yang SJ
• Kim HS
• Yoo HJ
• Park SY
• Ryu OH
• Lee KW
• Kim HY
• Seo JA
• Kim SG
• Choi KM
• Baik SH
• Choi DS

• KMID: 2200849
• DOI: http://doi.org/10.3803/jkes.2006.21.4.333

Abstract

Sheehan's syndrome occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. The manifestations of this clinical syndrome are most often caused by a deficiency in the hormones produced by the anterior pituitary gland, whereas the neurohypophysis is usually preserved but can be involved in severe cases that manifest as diabetes insipidus. This is a report of Sheehan's syndrome that manifested with diabetes insipidus as presenting symptom 2 month's after delivery. The patient suffered massive bleeding, so received a blood transfusion. A combined pituitary stimulation and water deprivation test revealed deficiencies of not only anterior pituitary hormones, such as growth hormone and prolactin, but also of anti-diuretic hormone. We report this case, with a review of the literature.

MeSH Terms

Blood Transfusion
Diabetes Insipidus
Diabetes Insipidus, Neurogenic*
Growth Hormone
Hemorrhage
Humans
Hypopituitarism*
Necrosis
Pituitary Gland, Anterior
Pituitary Gland, Posterior
Pituitary Hormones, Anterior
Postpartum Hemorrhage
Prolactin
Water Deprivation
Growth Hormone
Pituitary Hormones, Anterior
Prolactin

Figure

• 

  Fig. 1 Sella MRI. Sagital T1 weighted image shows pituitary fossa replaced by cerebrospinal fluid and the absence of normal posterior pituitary bright spot in the posterior pituitary gland.

Reference

1. Sheehan HL. Postpartum necrosis of the anterior pituitary. J Pathol Bact. 1937. 45:189–214.

2. Lee SK, Yun JH, Kang YS, Kim DJ, Choi YY, Hwang HY, Park HY, Kang MH. A case of diabetes insipidus in patient with Sheehan's syndrome. J Kor Soc Endocrinol. 1996. 11:108–113.

3. Sheehan HL. The frequency of postpartum hypopituitarism. J Obstet Gynaecol Br Commonw. 1965. 72:103–111.

4. Kovacs K. Sheehan syndrome. Lancet. 2003. 361:520–522.

5. Goluboff LG, Ezrin C. Effect of pregnancy on the somatotroph and the prolactin cell of the human adenohypophysis. J Clin Endocrinol Metab. 1969. 29:1533–1538.

6. Dejager S, Gerber S, Foubert L, Turpin G. Sheehan's syndrome: Differential diagnosis in the acute phase. J Intern Med. 1998. 244:261–266.

7. Haddock L, Vega LA, Aguilo F, Rodriguez O. Adrenocortical, thyroidal and human growth hormone reserve in Sheehan's syndrome. Johns Hopkins Med J. 1972. 131:80–99.

8. Kelestimur F. GH deficiency and the degree of hypopituitarism. Clin Endocrinol. 1995. 42:443–444.

9. Sheehan HL, Whithead R. The neurohypophysis in postpartum hypopituitarism. J Pathol Bacteriol. 1963. 85:145–169.

10. Whitehead R. The hypothalamus in postpartum hypopituitarism. J Pathol Bacteriol. 1963. 86:55–67.

11. Kan AKS, Calligerous D. A case report of Sheehan's syndrome presenting with diabetes insipidus. Aust NZ J Obstet Gynaecol. 1998. 38:224–226.

12. Bakiri F, Benmiloud M. Antidiuretic function in Sheehan's syndrome. Br Med J. 1984. 289:579–580.

13. Aguilo F Jr, Vega LA, Haddock L, Rodriguez O Jr. Diabetes insipidus syndrome in hypopituitarism of pregnancy. Case report and a critical review of the literature. Acta Endocrinol. 1969. 60:suppl. 137.

14. Tulandi T, Yusuf N, Posner BI. Diabetes insipitus: A postpartum complication. Obstet Gynecol. 1987. 70:492–495.

15. Tien R, Kucharczk J, Kucharczk W. MR imaging of the brain in patients with diabetes insipidus. Am J Neuroradiol. 1991. 12:533–542.

16. Kelestimur F, Jonsson P, Molvalilar S, Gomez JM, Auernhammer CJ, Colak R, Koltowska-Haggstrom M, Goth MI. Sheehan's syndrome: baseline characteristics and effects of 2 years of growth hormone replacement therapy in 91 patients in KIMS-Pfizer International Metabolic Database. Eur J Endocrinol. 2005. 152:581–587.

17. Iwasaki Y, Oiso Y, Yamauchi K, Takatsuchi K, Kondo K, Hasegawa H, Itatsu T, Niinomi M, Tomita A. Neurohypopyseal function in postpartum hypopituitarism: Impaired plasma vasopressin response to osmotic stimuli. J Clin Endocrinol Metab. 1989. 68:560–565.

18. Bakiri F, Benmiloud M, Valloton MB. Arginine-vasopressin in postpartum panhypopituitarism: urinary excretion and kidney response to osmolar load. J Clin Endocrinol Metab. 1984. 58:511–515.