J Korean Soc Endocrinol.  2001 Feb;16(1):39-53.

The Combined Pituitary Stimulation Test in Patients Suffered from Massive Postpartum Hemorrhage

• Kim SH
• Yang IM
• Park CY
• Oh SJ
• Kim DY
• Woo JT
• Kim SW
• Kim JW
• Kim YS
• Kim SW
• Choi YK

Abstract

BACKGROUND
ackground: Sheehan's syndrome secondary to severe postpartum hemorrhage is one of the major causes of pituitary insufficiency in Korea. Most of these patients do not manifest symptoms or signs of gross endocrinopathies. Earlier detection of pituitary insufficiency is of clinical importance. The combined pituitary stimulation test that uses the four hypothalamic releasing hormones is a rapid, safe, and effective way to evaluate anterior pituitary function. However, the criteria for a normal response has not been established in Korea.
METHODS
Combined anterior pituitary stimulation tests were performed on fourteen healthy women who had no history of endocrine disease. Combined tests of anterior pituitary reserve were done no forty-five patients who suffered from massive postpartum hemorrhage which required transfusing, along with subsequent shock or changing consciousness and in thirty-nine patients who experienced mild postpartum hemorrhage.
RESULTS
1) In the severe hemorrhage group, thirty-three of forty-five women (73.3%) showed blunted responses in more than one of the anterior pituitary hormones in the combined pituitary stimulation tests. However, in the mild hemorrhage group, only eighteen of thirty-nine women (46.2%) demonstrated blunted responses of more than one of the anterior pituitary hormones. 2) In the severe hemorrhage group, the TSH response was blunted in twenty-five patients (55.6%), prolactin in eleven patients (24.4%), ACTH in ten patients (22.2%), LH in ten patients (22.2%), GH in nine patients (20%), and FSH in five patients (11.1%). 3) The results of combined pituitary stimulation tests in the normal control group were different from the results of other studies.
CONCLUSION
It is recommended that the women who experienced a severe postpartum hemorrhage should be evaluated by using the combined pituitary stimulation test. Moreover, criteria for a normal response to the combined pituitary stimulation test should be established in Korea.

MeSH Terms

Adrenocorticotropic Hormone
Consciousness
Endocrine System Diseases
Female
Hemorrhage
Humans
Hypopituitarism
Korea
Pituitary Hormone-Releasing Hormones
Pituitary Hormones, Anterior
Postpartum Hemorrhage*
Postpartum Period*
Prolactin
Shock
Adrenocorticotropic Hormone
Pituitary Hormone-Releasing Hormones
Pituitary Hormones, Anterior
Prolactin