Acute Sheehan’s Syndrome Presenting with Hyponatremia Followed by a Spontaneous Pregnancy

Table 2

Reported cases of acute Sheehan’s syndrome.

Authors	Age (y)	Time of diagnosis related to delivery	Symptoms at presentation	Hypo natremia	Hormone deficit at diagnosis	Hormone recovery	CT scan at diagnosis	CT scan at F/U	Pituitary MRI at diagnosis	Pituitary MRI at follow-up
Putterman et al. [3]	27	7 days	Paresthesia, headache, weakness, somnolence	Yes	LH/FSH, TSH, ACTH	No	Pituitary infarction, increased CSF surrounding gland	Empty sella (6 months postpartum)
Zuker [12]	20	14 hours	Hypoglycemia	No	ACTH	No	No enhancing pituitary (ischemia)	Small, well enhancing pituitary (3 months after postpartum)
Lavalle et al. [13]	30	6 hours	Seizures	Yes	TSH, ACTH	TSH, ACTH	Normal	Peripherally enhancing sellar mass with suprasellar extension (5 days after delivery)	Intrasellar mass with suprasellar extension with peripheral enhancement	Atrophic gland (48 days after delivery)
Kan and Calligerous[14]	32	24 hours	Polydipsia and polyuria	No	FSH/LH, TSH, ACTH, ADH	ADH	Normal pituitary gland
Dejager et al. [15]	32	3 days	Headache, polydipsia, and polyuria	No	GH, LH/FSH, PRL, ADH	No			Holosellar 11-mm mass, pituitary gland did not enhance with contrast, peripheral rim	Shrinkage of pituitary mass of 4 mm, and dissappearance of bright neurophypophysis spot (30 days after delivery
Boulanger et al [16]	30	10 days	Asthenia, failure to lactate	Yes	LH/FSH, TSH, ACTH, PRL	Not reported
Kale et al. [17]	23	20 days	Psychosis	No	FSH/LH, TSH, ACTH	Not reported		Empty sella
Schrager et al. [18]	39	12 days	Nausea, vomiting, fatigue, dizziness, diarrhea	Yes	TSH, ACTH	Not reported
Lust et al. [19]	32	3 days	Headache, failure to lactate	Yes	TSH, ACTH	No			Enlarged pituitary isointense T1 abutting optic chiasm with peripheral gland enhancement	Empty sella (4 months after delivery)
Wang et al. [20]	32	7 days	Polyuria, renal insufficiency	Yes	LH/FSH, TSH, ACTH	Not reported
Bunch et al. [21]	23	6 days	Fatigue, diffuse abdominal pain, weakness, hypoglycemia	Yes	TSH, ACTH	Not reported			Enlarged pituitary gland, peripheral enhancement	Normal-sized pituitary gland with heterogen-eous uptake of contrast (1 month after delivery)
Munz et al. [22]	33	6 days	Stupor, headache, nausea, vomiting	Yes	TSH, ACTH, PRL	Yes	Normal		Normal
Wang et al. [23]	33	19 days	Respiratory distress	No	LH/FSH, TSH, ACTH, PRL	Not reported			Normal	Empty sella (day 32 after delivery)
Kaplun et al. [24]	29	17 days	Fatigue, failure to lactate, fever, postural syncope	Yes	GH, LH/FSH, TSH, ACTH, PRL	No			Nonenhancing minimally hypointense lesion in pituitary gland	Empty sella (6 months after delivery)
Kaplun et al. [24]	21	3 days	Headache, fever	Yes	GH, LH/FSH, TSH, ACTH, PRL	No			Enlarged pituitary gland with suprasellar extension, peripheral enhancement with an irregular and poorly enhanced central portion	Empty sella (11 months after delivery)
Anfuso et al. [25]	35	8 days	Asthenia, headache, abdominal pain	Yes	GH, LH/FSH, TSH, ACTH, PRL	No			Lack of enhancement of pituitary gland	Atrophy of adenohypophysis
Kumar et al. [26]	36	4 days	Polyuria	No	TSH, ACTH, PRL, ADH	No			Normal	Normal
Robalo et al. [27]	45	15 days	Headache, fatigue, polydipsia olyuria	No	GH, LH/FSH, TSH, ACTH, PRL, ADH	No	Discrete enlargement of anterior pituitary lobe, hypointense after contrast		Normal pituitary Ectopic posterior pituitary
Shoib et al. [28]	31	16–18 days	Psychosis, failure to lactate	No	LH/FSH, TSH, ACTH	Not reported		Empty sella
Sasaki et al. [29]	37	4–6 days	Failure to lactate	Yes	GH, LH/FSH, TSH, ACTH, PRL	No			Slight swelling of anterior lobe and pituitary stalk. There was no enhancement of central portion but a peripheral rim of enhancement	Empty sella
Hale et al. [30]	31	6 days	Severe headaches, failure to lactate, orthostatic hypotension, nausea and vomiting	Yes	TSH, ACTH, PRL, ADH	No			Infarcted enlarged pituitary with an expanded sella, with peripheral rim enhancement after contrast	NA
Matsuzaki et al. [1]	27	8 days	Seizure	Yes	GH, FSH/LH, TSH, ACTH, PRL	No			No abnormalities	Atrophic pituitary gland
Windpessl et al. [31]	31	8 days	Headache, lethargy, postural light-headedness, failure to lactate	Yes	TSH, ACTH	No			Pituitary hyperintense	Pituitary infarction
Rahim et al. [32]	27	2 days	Severe bifrontal headache and photophobia, failure to lactate	No	No	No	Subtly enlarged pituitary gland with an area of focal hypodensity		Acute pituitary infarction
Meregildo-Rodriguez [33]	24	4 days	Hypoglycemia, seizures	No	GH, FSH/LH, ACTH, TSH, PRL	No	Normal		Normal
Rahmani Tzvi-Ran et al. [34]	24	1 day	Headache, fatigue, and failure to lactate	Yes	GH, FSH/LH, TSH, ACTH, PRL, ADH	No			Normal pituitary with circumferential enhancement
Olmes et al. [35]	28	2 days	Failure to lactate, polyuria.	No	FSH/LH, TSH, ACTH, ADH	No