Síndrome de Sheehan : uma revisão

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018A Síndrome de Sheehan, também conhecida como necrose pituitária pós-parto, refere-se ao desenvolvimento de hipopituitarismo em consequência da necrose da hipófise. Este evento é, habitualmente, precipitado por hemorragia uterina maciça durante o parto e/ou no período pós-parto mas acredita-se que outras condições também possam estar na origem da síndrome como a aumento fisiológico da glândula que não é acompanhado pelo aumento da irrigação sanguínea, alterações na coagulação que podem predispor a trombose e, possivelmente, uma sela turca de dimensões inferiores ao normal. A perpetuação e agravamento da disfunção podem estar associadas a alterações autoimunitárias. Devido a relações anatómicas, a hipófise anterior é mais frequentemente lesada resultando em défice de hormona do crescimento, hipoadrenalismo, hipotiroidismo, hipoprolactinémia, e hipogonadismo secundário. A Diabetes Insípida é a forma clínica associada à disfunção da hipófise posterior. A sua instalação pode ser súbita ou crónica e, com maior frequência, desenvolve-se hipopituitarismo parcial com sintomas muito pouco específicos e insidiosos. A clínica mais sugestiva consiste na história de hemorragia pós-parto e subsequente agalactia e amenorreia. Ainda assim, muitas mulheres permanecem anos sem diagnóstico. Achados laboratoriais, imagiológicos e testes dinâmicos auxiliam e permitem estabelecer o diagnóstico definitivo. O tratamento consiste na substituição dos défices hormonais em falta. A Síndrome de Sheehan é uma condição com elevada morbilidade e mortalidade e, como tal, a comunidade médica deve estar mais sensibilizada para que o diagnóstico e tratamento possa ser feito o mais precocemente possível.Sheehan's syndrome, also known as postpartum pituitary necrosis, refers to hypopituitarism as a consequence of necrosis of the pituitary gland. This event is precipitated by massive uterine hemorrhage during or after labor. Other factors may also predispose for the ischemia such as pregnancy physiological hypertrophy of the hypophysis and impaired blood supply, coagulation dysfunction system leading to thrombosis and, possibly, a smaller sella turca. Autoimmune changes may contribute to the perpetuation and worsening of the hypopituitarism. Due to anatomical relationships, the anterior pituitary is more frequently injured resulting in possible deficit of growth hormone, hypoadrenalism, hypothyroidism, hypoprolactinemia, and secondary hypogonadism. Insipid Diabetes is the clinical manifestation of the posterior pituitary dysfunction. Symptoms may be present acutely or chronically and usually only partial hypopituitarism develops with unspecific symptoms. History of postpartum hemorrhage and subsequent agalactia and amenorrhea are very suggestive of Sheehan’s Syndrome. Still, many women remain years without diagnosis. Laboratory, imaging and dynamic tests help to establish a definitive diagnosis. Treatment consists of hormone replacement therapy. Sheehan’s syndrome is a condition with high morbidity and mortality, that’s why medical community should be more aware of it so that the diagnosis and treatment can be made as early as possible

A National Wide Collaborative Study

INTRODUCTION: Even though the risk of COVID-19 in pregnancy may be increased, large-scale studies are needed to better understand the impact of the infection in this population. The aim of this study is to describe obstetric complications and the rate of vertical transmission in pregnant women with SARS-CoV-2 infection. MATERIAL AND METHODS: Detected cases of SARS-CoV-2 infection in pregnancy were registered in Portuguese hospitals by obstetricians. Epidemiological, pregnancy and childbirth data were collected. RESULTS: There were 630 positive cases in 23 Portuguese maternity hospitals, most at term (87.9%) and asymptomatic (62.9%). The most frequent maternal comorbidity was obesity. The rates of preterm birth and small-to-gestational-age were 12.1% and 9.9%, respectively. In the third trimester, 2.9% of pregnant women required respiratory support. There were eight cases (1.5%) of fetal death, including two cases of vertical transmission. There were five cases of postpartum respiratory degradation, but no maternal deaths were recorded. The caesarean section rate was higher in the first than in the second wave (68.5% vs 31.5%). RT-PCR SARS-CoV-2 positivity among newborns was 1.3%. CONCLUSION: SARS-Cov-2 infection in pregnancy may carry increased risks for both pregnant women and the fetuses. Individualized surveillance and the prophylaxis of this population with vaccination. is recommended in these cases.publishersversionepub_ahead_of_prin