Introduction: Rapid correction of hyponatremia can result in osmotic demyelination syndrome (ODS). Sheehan's syndrome, a rare pituitary disorder caused by severe postpartum hemorrhage, is a potential cause of chronic hyponatremia. This case report describes a rare progression of extrapontine myelinolysis to central pontine myelinolysis, ultimately leading to ODS, following the correction of chronic hyponatremia associated with Sheehan's syndrome. Notably, this event occurred a decade after the initial postpartum hemorrhage due to placenta previa.
Case Report: A 40-year-old woman from rural West Bengal, India, presented in a comatose state after five years of progressively worsening symptoms, including fatigue, gastrointestinal disturbances, cold intolerance, hair loss, and severe apathy, which had been misdiagnosed as psychogenic and treated with selective serotonin reuptake inhibitors. Two days before her admission to our hospital, she was diagnosed with a lower respiratory tract infection, dehydration, and severe hyponatremia (118 mEq/L) at a local private healthcare facility. Despite treatment with 3% sodium chloride and intravenous antibiotics, her condition deteriorated, prompting her transfer. At the time of hospitalization, the patient was diagnosed with chronic hyponatremia and hypopituitarism consistent with Sheehan's syndrome. This condition was attributed to a severe postpartum hemorrhage that occurred a decade prior, resulting from placenta previa. Initial MRI revealed extrapontine myelinolysis, and the correction of her "compensated" hyponatremia was identified as the cause of her neurological decline. Follow-up MRIs at 7 and 14 weeks confirmed the development of cavitating ODS.
Discussion: This case highlights several key points: First, even a relatively gradual correction of hyponatremia can precipitate ODS, especially in patients with chronic conditions like Sheehan's syndrome. Second, it underscores the importance of meticulous management of chronic hyponatremia to prevent severe neurological outcomes. Third, it illustrates the diagnostic challenges of differentiating Sheehan's syndrome from primary psychiatric disorders, particularly in low-resource settings where the syndrome remains prevalent. The case also emphasizes the need for awareness among healthcare providers about the potential for severe complications arising from even minor corrections in serum sodium levels in such patients.
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http://dx.doi.org/10.1177/19418744241279491 | DOI Listing |
Pituitary
December 2024
Department of Internal Medicine, General Hospital 71, Mexican Social Security Institute, Veracruz, Mexico.
Endocr Pract
December 2024
Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Objective: Sheehan syndrome (SS), or postpartum pituitary necrosis occurs due to reduced vascular supply following postpartum hemorrhage, often linked to coagulation abnormalities, and pituitary antibodies. A smaller sella turcica volume is a risk factor for SS, consequent to compressive effects on the pituitary stalk. Hypopituitarism in SS increases the risk of metabolic liver and bone diseases.
View Article and Find Full Text PDFCancers (Basel)
December 2024
Department of Neurosurgery, Hannover Medical School, 30625 Hannover, Germany.
Background: Pituitary apoplexy is a potentially life-threatening condition that most often results from hemorrhage into a preexisting pituitary neuroendocrine tumor (PitNet) presenting with acute headache, visual impairment and endocrine dysfunction. Here, we aimed to identify factors associated with hemorrhage and present the pituitary hormonal status before and after transnasal-transsphenoidal tumor removal in a comparative study design.
Methods: A series of 100 patients with PitNet were analyzed.
J Neurotrauma
December 2024
Center for Neurologic Studies, Boca Raton, Florida, USA.
Traumatic brain injury (TBI) is frequently associated with hypopituitarism. The hypothalamic-pituitary axis appears to be susceptible to the same forces that cause injury to the parenchyma of the brain. Following even a mild TBI (mTBI), patients may suffer transient or permanent decreases in anterior pituitary hormones, including somatotropin (growth hormone [GH]), gonadotropins (luteinizing hormone and follicle-stimulating hormone), thyrotropin, and adrenocorticotropic hormone, with the most frequent long-term deficiency being GH deficiency (GHD).
View Article and Find Full Text PDFSarcoidosis is an immune-mediated multisystem condition of unknown etiology, characterized by non-caseating granulomatous inflammation. While it commonly affects the lungs and the reticuloendothelial system, it can affect any organ. Most of such cases involve the central nervous system, but the condition rarely presents with symptoms related to hypothalamic-pituitary dysfunction.
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