Sheehan’s Syndrome (SS) occurs as a result of ischemic pituitary necrosis due to severe post-partum hemorrhage. We report a 41-year-old woman with a history of severe postpartum hemorrhage 18 years prior to presentat...Sheehan’s Syndrome (SS) occurs as a result of ischemic pituitary necrosis due to severe post-partum hemorrhage. We report a 41-year-old woman with a history of severe postpartum hemorrhage 18 years prior to presentation. During this period of time, she experienced severe fatigue. Three months prior to being admitted to our hospital, the patient started to notice alopecia, generalized edema and cognitive impairment. After proper investigation, laboratory tests and clinical findings indicated panhypopituitarism. In addition to neuroimaging and past medical history, SS was diagnosed and treatment started. We emphasize the importance of thorough investigation, further diagnosis and management of this condition (especially in third world countries), since SS is a neurological and endocrinological emergency and potentially life threatening.展开更多
背景希恩综合征患者在救治过程中出现精神异常的案例时有报道,并发垂体危象者表现更为突出,这给进一步的救治带来困难,目前关于希恩综合征并发垂体危象患者发生精神异常相关影响因素的研究较少。目的探讨希恩综合征并发垂体危象的患者...背景希恩综合征患者在救治过程中出现精神异常的案例时有报道,并发垂体危象者表现更为突出,这给进一步的救治带来困难,目前关于希恩综合征并发垂体危象患者发生精神异常相关影响因素的研究较少。目的探讨希恩综合征并发垂体危象的患者治疗过程中发生精神异常的影响因素。方法选取2010年1月—2019年8月于遵义医科大学附属医院内分泌科住院治疗的并发垂体危象的希恩综合征患者47例为研究对象,根据是否发生精神异常分为精神异常组(PS组,n=20)及非精神异常组(NPS组,n=27)。测量患者血压、身高、体质量,计算其体质指数(BMI),采集治疗前肘静脉血测血红蛋白、血清钠离子、血糖、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、卵泡刺激素(FSH)、黄体生成素(LH)、催乳素(PRL)、雌二醇(E2)、生长激素(GH)、促肾上腺皮质激素(ACTH)、皮质醇(COR),空腹采集静脉血测总胆固醇(TC)、三酰甘油(TG),收集首个24 h氢化可的松(HC)用量及发生精神异常前HC的累积用量,并比较两组间有无差异。采用二元Logistic回归分析探讨发生精神异常的影响因素,采用受试者工作特征(ROC)曲线评价血清钠离子水平、24 h HC及血清钠离子联合24 h HC对希恩综合征并发垂体危象患者出现精神异常的预测价值。结果PS组SBP、血清钠离子水平低于NPS组,而ACTH、24 h HC、发生精神异常前HC的累积用量高于NPS组(P<0.05)。二元Logistic回归分析结果显示,血清钠离子水平〔OR=0.848,95%CI(0.761,0.945)〕、24 h HC〔OR=1.066,95%CI(1.006,1.130)〕是发生精神异常的影响因素(P<0.05)。24 h HC预测精神异常发生的ROC曲线下面积(AUC)为0.756〔95%CI(0.614,0.897),P<0.01〕,最佳截断值为135.0 mg,灵敏度为0.750,特异度为0.667;血清钠离子预测精神异常发生的AUC为0.744〔95%CI(0.599,0.890),P<0.01〕,最佳截断值为119.6 mmol/L,灵敏度为0.741,�展开更多
文摘Sheehan’s Syndrome (SS) occurs as a result of ischemic pituitary necrosis due to severe post-partum hemorrhage. We report a 41-year-old woman with a history of severe postpartum hemorrhage 18 years prior to presentation. During this period of time, she experienced severe fatigue. Three months prior to being admitted to our hospital, the patient started to notice alopecia, generalized edema and cognitive impairment. After proper investigation, laboratory tests and clinical findings indicated panhypopituitarism. In addition to neuroimaging and past medical history, SS was diagnosed and treatment started. We emphasize the importance of thorough investigation, further diagnosis and management of this condition (especially in third world countries), since SS is a neurological and endocrinological emergency and potentially life threatening.
文摘背景希恩综合征患者在救治过程中出现精神异常的案例时有报道,并发垂体危象者表现更为突出,这给进一步的救治带来困难,目前关于希恩综合征并发垂体危象患者发生精神异常相关影响因素的研究较少。目的探讨希恩综合征并发垂体危象的患者治疗过程中发生精神异常的影响因素。方法选取2010年1月—2019年8月于遵义医科大学附属医院内分泌科住院治疗的并发垂体危象的希恩综合征患者47例为研究对象,根据是否发生精神异常分为精神异常组(PS组,n=20)及非精神异常组(NPS组,n=27)。测量患者血压、身高、体质量,计算其体质指数(BMI),采集治疗前肘静脉血测血红蛋白、血清钠离子、血糖、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、卵泡刺激素(FSH)、黄体生成素(LH)、催乳素(PRL)、雌二醇(E2)、生长激素(GH)、促肾上腺皮质激素(ACTH)、皮质醇(COR),空腹采集静脉血测总胆固醇(TC)、三酰甘油(TG),收集首个24 h氢化可的松(HC)用量及发生精神异常前HC的累积用量,并比较两组间有无差异。采用二元Logistic回归分析探讨发生精神异常的影响因素,采用受试者工作特征(ROC)曲线评价血清钠离子水平、24 h HC及血清钠离子联合24 h HC对希恩综合征并发垂体危象患者出现精神异常的预测价值。结果PS组SBP、血清钠离子水平低于NPS组,而ACTH、24 h HC、发生精神异常前HC的累积用量高于NPS组(P<0.05)。二元Logistic回归分析结果显示,血清钠离子水平〔OR=0.848,95%CI(0.761,0.945)〕、24 h HC〔OR=1.066,95%CI(1.006,1.130)〕是发生精神异常的影响因素(P<0.05)。24 h HC预测精神异常发生的ROC曲线下面积(AUC)为0.756〔95%CI(0.614,0.897),P<0.01〕,最佳截断值为135.0 mg,灵敏度为0.750,特异度为0.667;血清钠离子预测精神异常发生的AUC为0.744〔95%CI(0.599,0.890),P<0.01〕,最佳截断值为119.6 mmol/L,灵敏度为0.741,�
