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Acute renal failure: A rare presentation of Sheehan's syndrome.

Bhat MA, Laway BA, Allaqaband FA, Kotwal SK, Wani IA, Banday KA - Indian J Endocrinol Metab (2012)

Bottom Line: Sheehan's syndrome occurs as a result of ischemic pituitary necrosis secondary to severe postpartum bleeding.It is one of the most common causes of hypopituitarism, characterized by variable clinical presentation.Acute kidney injury occurs rarely in Sheehan's syndrome and most of the cases have been found to be precipitated by rhabdomyolysis.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.

ABSTRACT
Sheehan's syndrome occurs as a result of ischemic pituitary necrosis secondary to severe postpartum bleeding. It is one of the most common causes of hypopituitarism, characterized by variable clinical presentation. Acute kidney injury occurs rarely in Sheehan's syndrome and most of the cases have been found to be precipitated by rhabdomyolysis. We here present a case of Sheehan's syndrome with acute kidney injury where theprecipitating cause was chronic hypocortisolemia. We believe this is the first reported case of Sheehan's syndrome in which acute kidney injury was precipitated by adrenal insufficiency.

No MeSH data available.


Related in: MedlinePlus

MRI pituitary sagittal view showing pituitary fossa filled with cerebrospinal fluid and stalk touching the base of pituitary floor; features suggestive of empty sella
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Figure 1: MRI pituitary sagittal view showing pituitary fossa filled with cerebrospinal fluid and stalk touching the base of pituitary floor; features suggestive of empty sella

Mentions: The patient was given intravenous fluids in the form of dextrose normal saline with close monitoring of urine output, replacement therapy in the form of intravenous hydrocortisone 50 mg intravenously 6 hourly, and levothyroxine given orally at a starting dose of 50 mcg/ day. The patient was also given intravenous antibiotics and antiemetics. Urine output began to improve on the 2nd day of admission. Her appetite also improved and there was complete cessation of vomiting. On repeating renal function tests and other biochemical tests, there was dramatic improvement in serial renal function parameters. With improvement in the general condition of the patient, intravenous antibiotics were stopped in view of absence of fever and negative septic screen. She was shifted to oral prednisolone 5 mg twice daily, while levothyroxine was continued at a dose of 50 mcg/day. The serial biochemical parameters of the patient are given in Table 1. She was discharged on the same medication on 10th day of admission and was advised to taper prednisolone to 5 mg/ day after 2 weeks. Four weeks after discharge, the patient had general sense of well-being with better appetite and renal function had normalized with creatinine 0.64 mg/ dl and serum urea 23 mg/dl. The patient was subjected to magnetic resonance imaging (MRI) brain with sellar and parasellar focus which revealed empty sella with normal rest of the brain parenchyma [Figure 1].


Acute renal failure: A rare presentation of Sheehan's syndrome.

Bhat MA, Laway BA, Allaqaband FA, Kotwal SK, Wani IA, Banday KA - Indian J Endocrinol Metab (2012)

MRI pituitary sagittal view showing pituitary fossa filled with cerebrospinal fluid and stalk touching the base of pituitary floor; features suggestive of empty sella
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3313757&req=5

Figure 1: MRI pituitary sagittal view showing pituitary fossa filled with cerebrospinal fluid and stalk touching the base of pituitary floor; features suggestive of empty sella
Mentions: The patient was given intravenous fluids in the form of dextrose normal saline with close monitoring of urine output, replacement therapy in the form of intravenous hydrocortisone 50 mg intravenously 6 hourly, and levothyroxine given orally at a starting dose of 50 mcg/ day. The patient was also given intravenous antibiotics and antiemetics. Urine output began to improve on the 2nd day of admission. Her appetite also improved and there was complete cessation of vomiting. On repeating renal function tests and other biochemical tests, there was dramatic improvement in serial renal function parameters. With improvement in the general condition of the patient, intravenous antibiotics were stopped in view of absence of fever and negative septic screen. She was shifted to oral prednisolone 5 mg twice daily, while levothyroxine was continued at a dose of 50 mcg/day. The serial biochemical parameters of the patient are given in Table 1. She was discharged on the same medication on 10th day of admission and was advised to taper prednisolone to 5 mg/ day after 2 weeks. Four weeks after discharge, the patient had general sense of well-being with better appetite and renal function had normalized with creatinine 0.64 mg/ dl and serum urea 23 mg/dl. The patient was subjected to magnetic resonance imaging (MRI) brain with sellar and parasellar focus which revealed empty sella with normal rest of the brain parenchyma [Figure 1].

Bottom Line: Sheehan's syndrome occurs as a result of ischemic pituitary necrosis secondary to severe postpartum bleeding.It is one of the most common causes of hypopituitarism, characterized by variable clinical presentation.Acute kidney injury occurs rarely in Sheehan's syndrome and most of the cases have been found to be precipitated by rhabdomyolysis.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.

ABSTRACT
Sheehan's syndrome occurs as a result of ischemic pituitary necrosis secondary to severe postpartum bleeding. It is one of the most common causes of hypopituitarism, characterized by variable clinical presentation. Acute kidney injury occurs rarely in Sheehan's syndrome and most of the cases have been found to be precipitated by rhabdomyolysis. We here present a case of Sheehan's syndrome with acute kidney injury where theprecipitating cause was chronic hypocortisolemia. We believe this is the first reported case of Sheehan's syndrome in which acute kidney injury was precipitated by adrenal insufficiency.

No MeSH data available.


Related in: MedlinePlus