Sheehan’s syndrome

Sheehan’s syndrome is postpartum hypopituitarism resulting from pituitary necrosis due to severe hypotension or shock secondary to massive bleeding during or following delivery. Sheehan’s syndrome is one of the neglected endocrine disorders. Although the definite mechanisms have not been clearly defined; disturbed blood supply of the pituitary gland due to hypotension in addition to increased demand of the gland due to physiological enlargement during gestation, relatively small sella size and autoimmunity in the longterm are suggested factors that are involved in the pathogenesis. Sheehan’s syndrome is characterized by variable degrees of hypopituitarism. Patients may have isolated, partial or complete hypopituitarism and they present with symptoms or signs due to the deficient hormone(s). The main difference from hypopituitarism due to other causes, such as pituitary adenoma or pituitary surgery, is the severity of the hormonal insufficiency. The symptoms and signs depend on the type and the severity of the underlying hormonal insufficiency. A history of failure of postpartum lactation and resumption of normal menses are the most common diagnostic features suggesting Sheehan’s syndrome. Partial or complete empty sella on MRI or CT is almost always seen in the patients. Treatment includes appropriate replacement of deficient hormones

A comparison between short synacthen test and depot synacthen test in the evaluation of cortisol reserve of adrenal gland in normal subjects

Synacthen test has been widely used as a screening test for evaluation of adrenal cortisol reserve. We investigated whether depot Synacthen test can be used in place of short Synacthen test in the evaluation of cortisol reserve of the adrenal gland. The study included 20 healthy volunteers of both sexes. We examined plasma cortisol response 30, 60, 90, and 120 min after administration of plain Synacthen, 250 mu g, iv (Group 1), and depot Synacthen, 1000 mu g, im (Group 2), Peak cortisol values were statistically similar between the groups. The increment in cortisol levels following Synacthen was also similar between the groups, A plasma cortisol value above 550 or 600 nmol/L was achieved in both groups during the test of 90 or 120 minutes duration, respectively, We think that depot Synacthen test, im 1000 mu g, may be used in place of plain Synacthen, iv 250 mu g, for evaluation of adrenal cortisol reserve