Snapshot A 25-year-old woman presents with her 4-day-old girl, born at full-term via spontaneous vaginal delivery complicated by postpartum hemorrhage, for a follow-up pediatric visit. She reports that she has not been breastfeeding, as her milk never “came in.” She has been feeding only with formula. (Sheehan syndrome) Introduction Introduction clinical definition hypopituitarism ↓ secretion of pituitary hormones etiologies pituitary adenoma craniopharyngioma brain damage radiation therapy Sheehan syndrome empty sella syndrome pituitary apoplexy Studies morning serum levels of pituitary hormones insulin-like growth factor luteinizing hormone (LH) follicle-stimulating hormone (FSH) sex steroids testosterone estradiol thyroid-stimulating hormone (TSH) free thyroxine (T4) cortisol adrenocorticotropic hormone (ACTH) prolactin Treatment hormone replacement therapy corticosteroids sex steroids growth hormone thyroxine Sheehan Syndrome Sheehan syndrome definition pituitary infarction due to postpartum bleeding pathogenesis pregnancy causes increased pituitary size, predisposing the gland to hypoperfusion and ischemia secondary to hypovolemic shock from postpartum bleeding Presentation prolactin deficiency breast involution and failure to lactate amenorrhea hypothyroidism cold intolerance Imaging head magnetic resonance imaging (MRI) infarction of pituitary gland Empty Sella Syndrome Empty sella syndrome definition atrophy or compression of the pituitary gland pathogenesis often idiopathic risk factors obesity female associated conditions idiopathic intracranial hypertension Presentation headache fatigue may be asymptomatic Imaging head MRI pituitary fossa is replaced with cerebrospinal fluid rather than tissue Treatment often do not require treatment if asymptomatic Pituitary Apoplexy Pituitary apoplexy definition hemorrhage or infarction of pituitary gland often in the setting of an existing pituitary adenoma demographics male > female adults Presentation sudden-onset severe headache visual disturbance bilateral hemianopia diplopia altered mental status Imaging head computed tomography (CT) intrasellar mass with hemorrhage Treatment corticosteroids may require surgery
QUESTIONS 1 of 1 1 Previous Next (M2.EC.15.4404) A 28-year-old G2P1 female with a history of hypertension presents to the emergency room at 33 weeks with headache and blurry vision. On exam, her vitals include BP 186/102 mmHg, HR 102 beats per minute, RR 15 breaths per minute, and T 98.9 degrees Fahrenheit. She undergoes an immediate Caesarian section, and although she is noted to have large-volume blood loss during the procedure, the remainder of her hospital course is without complications. Four weeks later, the patient returns to her physician and notes that she has had blurry vision and has not been able to lactate. A prolactin level is found to be 10 ng/mL (normal: 100 ng/mL). Which of the following is the most appropriate next step? QID: 106965 Type & Select Correct Answer 1 Galactogram 0% (0/20) 2 Observation of maternal-child interactions 0% (0/20) 3 Brain MRI 65% (13/20) 4 Head CT 30% (6/20) 5 Breast ultrasound 0% (0/20) M 6 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic