Sheehan's syndrome differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Sheehan%27s_syndrome]] | |||
{{CMG}}; {{AE}} {{IQ}} | {{CMG}}; {{AE}} {{IQ}} | ||
==Overview== | ==Overview== | ||
Sheehan syndrome must be differentiated from lymphocytic hypophysitis, pituitary apoplexy, hypothyroidism, Addison's disease, | Sheehan's syndrome must be differentiated from other diseases causing [[hypopituitarism]], such as [[lymphocytic hypophysitis]], [[pituitary apoplexy]], [[hypothyroidism]], [[Addison's disease]], [[panhypopituitarism]], [[empty sella syndrome]], [[hypogonadotropic hypogonadism]], [[Simmonds' disease]], hypoprolactinemia, and [[menopause]]. | ||
==Differentiating Sheehan's Syndrome from other Diseases== | ==Differentiating Sheehan's Syndrome from other Diseases== | ||
Sheehan's syndrome should be differentiated from other diseases causing hypopituitarism.<ref name="pmid9541295">{{cite journal |vauthors=Sato N, Sze G, Endo K |title=Hypophysitis: endocrinologic and dynamic MR findings |journal=AJNR Am J Neuroradiol |volume=19 |issue=3 |pages=439–44 |year=1998 |pmid=9541295 |doi= |url=}}</ref><ref name="pmid7758238">{{cite journal |vauthors=Powrie JK, Powell M, Ayers AB, Lowy C, Sönksen PH |title=Lymphocytic adenohypophysitis: magnetic resonance imaging features of two new cases and a review of the literature |journal=Clin. Endocrinol. (Oxf) |volume=42 |issue=3 |pages=315–22 |year=1995 |pmid=7758238 |doi= |url=}}</ref><ref name="pmid26262437">{{cite journal |vauthors=Honegger J, Schlaffer S, Menzel C, Droste M, Werner S, Elbelt U, Strasburger C, Störmann S, Küppers A, Streetz-van der Werf C, Deutschbein T, Stieg M, Rotermund R, Milian M, Petersenn S |title=Diagnosis of Primary Hypophysitis in Germany |journal=J. Clin. Endocrinol. Metab. |volume=100 |issue=10 |pages=3841–9 |year=2015 |pmid=26262437 |doi=10.1210/jc.2015-2152 |url=}}</ref><ref name="pmid7629223">{{cite journal |vauthors=Thodou E, Asa SL, Kontogeorgos G, Kovacs K, Horvath E, Ezzat S |title=Clinical case seminar: lymphocytic hypophysitis: clinicopathological findings |journal=J. Clin. Endocrinol. Metab. |volume=80 |issue=8 |pages=2302–11 |year=1995 |pmid=7629223 |doi=10.1210/jcem.80.8.7629223 |url=}}</ref><ref name="pmid8345854">{{cite journal |vauthors=Imura H, Nakao K, Shimatsu A, Ogawa Y, Sando T, Fujisawa I, Yamabe H |title=Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus |journal=N. Engl. J. Med. |volume=329 |issue=10 |pages=683–9 |year=1993 |pmid=8345854 |doi=10.1056/NEJM199309023291002 |url=}}</ref><ref name="pmid21668725">{{cite journal |vauthors=Hsieh CY, Liu BY, Yang YN, Yin WH, Young MS |title=Massive pericardial effusion with diastolic right ventricular compression secondary to hypothyroidism in a 73-year-old woman |journal=Emerg Med Australas |volume=23 |issue=3 |pages=372–5 |year=2011 |pmid=21668725 |doi=10.1111/j.1742-6723.2011.01425.x |url=}}</ref> | Sheehan's syndrome should be differentiated from other diseases causing [[hypopituitarism]].<ref name="pmid9541295">{{cite journal |vauthors=Sato N, Sze G, Endo K |title=Hypophysitis: endocrinologic and dynamic MR findings |journal=AJNR Am J Neuroradiol |volume=19 |issue=3 |pages=439–44 |year=1998 |pmid=9541295 |doi= |url=}}</ref><ref name="pmid7758238">{{cite journal |vauthors=Powrie JK, Powell M, Ayers AB, Lowy C, Sönksen PH |title=Lymphocytic adenohypophysitis: magnetic resonance imaging features of two new cases and a review of the literature |journal=Clin. Endocrinol. (Oxf) |volume=42 |issue=3 |pages=315–22 |year=1995 |pmid=7758238 |doi= |url=}}</ref><ref name="pmid26262437">{{cite journal |vauthors=Honegger J, Schlaffer S, Menzel C, Droste M, Werner S, Elbelt U, Strasburger C, Störmann S, Küppers A, Streetz-van der Werf C, Deutschbein T, Stieg M, Rotermund R, Milian M, Petersenn S |title=Diagnosis of Primary Hypophysitis in Germany |journal=J. Clin. Endocrinol. Metab. |volume=100 |issue=10 |pages=3841–9 |year=2015 |pmid=26262437 |doi=10.1210/jc.2015-2152 |url=}}</ref><ref name="pmid7629223">{{cite journal |vauthors=Thodou E, Asa SL, Kontogeorgos G, Kovacs K, Horvath E, Ezzat S |title=Clinical case seminar: lymphocytic hypophysitis: clinicopathological findings |journal=J. Clin. Endocrinol. Metab. |volume=80 |issue=8 |pages=2302–11 |year=1995 |pmid=7629223 |doi=10.1210/jcem.80.8.7629223 |url=}}</ref><ref name="pmid8345854">{{cite journal |vauthors=Imura H, Nakao K, Shimatsu A, Ogawa Y, Sando T, Fujisawa I, Yamabe H |title=Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus |journal=N. Engl. J. Med. |volume=329 |issue=10 |pages=683–9 |year=1993 |pmid=8345854 |doi=10.1056/NEJM199309023291002 |url=}}</ref><ref name="pmid21668725">{{cite journal |vauthors=Hsieh CY, Liu BY, Yang YN, Yin WH, Young MS |title=Massive pericardial effusion with diastolic right ventricular compression secondary to hypothyroidism in a 73-year-old woman |journal=Emerg Med Australas |volume=23 |issue=3 |pages=372–5 |year=2011 |pmid=21668725 |doi=10.1111/j.1742-6723.2011.01425.x |url=}}</ref><ref name="pmid9747750">{{cite journal |vauthors=Dejager S, Gerber S, Foubert L, Turpin G |title=Sheehan's syndrome: differential diagnosis in the acute phase |journal=J. Intern. Med. |volume=244 |issue=3 |pages=261–6 |year=1998 |pmid=9747750 |doi= |url=}}</ref> | ||
<small> | |||
{| class="wikitable" | {| class="wikitable" | ||
! rowspan="3" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Diseases}} | ! rowspan="3" style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Diseases}} | ||
Line 26: | Line 27: | ||
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Other features}} | ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Other features}} | ||
|- | |- | ||
![[Sheehan's syndrome]] | |||
|Acute | |Acute | ||
|<nowiki>++</nowiki> | |<nowiki>++</nowiki> | ||
| ++ | | ++ | ||
|Oligo/amenorrhea | |[[Oligomenorrhea|Oligo]]/[[amenorrhea]] | ||
| | |Symptoms of: | ||
* Adrenal insufficiency | * [[Adrenal insufficiency]] | ||
* Hypothyroidism | * [[Hypothyroidism]] | ||
| | | | ||
* Breast tissue atrophy | * [[Breast tissue]] [[atrophy]] | ||
* Decreased axillary and pubic hair growth | * Decreased [[axillary]] and [[pubic]] hair growth | ||
| | | | ||
* Pancytopenia | * [[Pancytopenia]] | ||
* Eosinophilia | * [[Eosinophilia]] | ||
* Hyponatremia | * [[Hyponatremia]] | ||
* Low fasting plasma glucose | * Low [[fasting plasma glucose]] | ||
* Decreased levels of anterior pituitary hormones in blood | * Decreased levels of [[anterior pituitary]] [[hormones]] in blood | ||
| | | | ||
* | * Clinical diagnosis | ||
* Most senitive test | * Most senitive test: Low baseline [[prolactin]] levels w/o response to [[Thyrotropin-releasing hormone|TRH]] | ||
|CT/MRI | |CT/MRI: | ||
* Sequential changes of pituitary enlargement followed by: | |||
* Shrinkage and [[necrosis]] leading to decreased sellar volume or [[empty sella]] | |||
| | | | ||
* Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests) | |||
|- | |- | ||
![[Lymphocytic hypophysitis]] | |||
|Acute | |Acute | ||
|<nowiki>+/-</nowiki> | |<nowiki>+/-</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|Oligo/amenorrhea | |[[Oligomenorrhea|Oligo]]/[[amenorrhea]] | ||
| | | | ||
* Associated with autoimmune conditions | * Associated with [[autoimmune]] conditions | ||
* Generalized [[headache]] | * Generalized [[headache]] | ||
Line 97: | Line 75: | ||
* Mass lesion effect such as [[Visual field defect|visual field defects]] | * Mass lesion effect such as [[Visual field defect|visual field defects]] | ||
| | | | ||
* DI | * [[Diabetes insipidus|DI]] | ||
* Autoimmune thyroiditis | * [[Autoimmune]] [[thyroiditis]] | ||
| | | | ||
* Decreased pituitary hormones(Gonadotropins most common) | * Decreased pituitary hormones([[Gonadotropins]] most common) | ||
* Hyperprolactinemia(40%) | * [[Hyperprolactinemia]](40%) | ||
* GH excess | * [[Growth hormone|GH]] excess | ||
| | | | ||
* [[CT]] & [[MRI]] | * [[Pituitary gland|Pituitary]] [[biopsy]]: [[lymphocytic]] [[Infiltration (medical)|infiltration]] | ||
| | |||
* [[CT]] & [[MRI]]: Features of a [[Pituitary gland|pituitary]] [[mass]] | |||
* Diffuse and homogeneous contrast enhancement | * Diffuse and homogeneous contrast enhancement | ||
| | |[[Assay|Assays]] for: | ||
* Anti-TPO Ab | |||
* Anti-Tg Ab | |||
|- | |- | ||
![[Pituitary apoplexy]] | |||
|Acute | |Acute | ||
|<nowiki>-</nowiki> | |<nowiki>+/-</nowiki> | ||
|<nowiki> | |<nowiki>++</nowiki> | ||
| | |[[Oligomenorrhea|Oligo]]/[[amenorrhea]] | ||
|Severe [[headache]] | |||
* [[Nausea and vomiting]] | |||
* Paralysis of eye muscles ([[diplopia]]) | |||
* Changes in vision | |||
| | | | ||
* [[ | * [[Visual acuity]] defects | ||
* [[ | * [[Cranial nerve palsies|CN palsies]] (nerves III, IV, V , and VI) | ||
| | | | ||
* | * Decreased levels of [[anterior pituitary]] hormones in blood. | ||
* [[ | | | ||
* [[Magnetic resonance imaging|MRI]] | |||
| | |||
* [[CT]] scan without [[Contrast medium|contrast]]: Hemorrhag<nowiki/>e on [[CT]] presents as a hyperdense lesion | |||
* [[MRI]]: If inconclusive [[CT]] | |||
| | | | ||
[[ | [[Blood tests]] may be done to check: | ||
* | * [[PT]]/[[INR]] and [[aPTT]] | ||
* | |||
* [[Pituitary gland|Pituitary]] [[hormonal]] assay | |||
|- | |- | ||
![[Empty sella syndrome]] | |||
|Chronic | |Chronic | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|Oligo/amenorrhea | |[[Oligomenorrhea|Oligo]]/[[amenorrhea]] | ||
| | | | ||
* Erectile dysfunction | * [[Erectile dysfunction]] | ||
* Headache | * [[Headache]] | ||
* Low libido | * Low [[libido]] | ||
| | | | ||
* Signs of raised intracranial pressure may be present | * Signs of raised [[intracranial pressure]] may be present | ||
* Nipple discharge | * [[Nipple discharge|Nipple]] discharge | ||
| | |||
| | | | ||
* Decreased levels of pituitary hormones in blood. | |||
| | |||
* [[MRI]] | |||
| | |||
* [[Empty sella]] containing [[Cerebrospinal fluid|CSF]] | |||
| | |||
* [[Pituitary]] hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests) | |||
|- | |- | ||
![[Simmond's Disease|Simmonds' disease]]/[[Pituitary]] [[cachexia]] | |||
|Chronic | |Chronic | ||
|<nowiki>+/-</nowiki> | |<nowiki>+/-</nowiki> | ||
| + | | + | ||
|Oligo/amenorrhea | |[[Oligomenorrhea|Oligo]]/[[amenorrhea]] | ||
| | | | ||
* Cachexia | * [[Cachexia]] | ||
* [[Premature aging|Premature]] aging | |||
* Premature aging | |||
| | | | ||
* Progressive emaciation | * Progressive [[emaciation]] | ||
* Loss of body hair | * Loss of body hair | ||
| | | | ||
* Decreased levels of [[anterior pituitary]] hormones in blood. | |||
| | | | ||
* [[Magnetic resonance imaging|MRI]] | |||
| | |||
* Done to rule out any [[pituitary]] cause | |||
| | |||
* [[Pituitary]] hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests) | |||
|- | |- | ||
! [[Primary hypothyroidism|Hypothyroidism]] | |||
|Chronic | |Chronic | ||
|<nowiki>+/-</nowiki> | |<nowiki>+/-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|Oligomenorrhea/menorrhagia | |[[Oligomenorrhea]]/[[menorrhagia]] | ||
| | | | ||
* Cold intolerance | * Cold intolerance | ||
* Constipation | * [[Constipation]] | ||
| | | | ||
* Dry skin | * Dry skin | ||
* Bradycardia | * [[Bradycardia]] | ||
* Hair loss | * Hair loss | ||
* Myxedema | * [[Myxedema]] | ||
* Delayed relaxation phase of deep tendon reflexes | * Delayed relaxation phase of deep [[Tendon reflex|tendon reflexes]] | ||
| | | | ||
* Low T3,T4 | * Low [[T3]],[[T4]] | ||
* | * Normal/low [[Thyroid-stimulating hormone|TSH]] | ||
* Rest of pituitary hormone levels | * Rest of [[pituitary]] hormone levels NL | ||
|TSH levels | | | ||
* [[TSH]] levels | |||
| | | | ||
* | * Done to rule out any [[pituitary]] cause | ||
| | |||
*Assays for anti-TPO Ab and anti-Tg Ab | |||
*FNA biopsy | |||
|- | |- | ||
![[Hypogonadotropic hypogonadism]] | |||
|Chronic | |Chronic | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|Oligo/amenorrhea | |[[Oligomenorrhea|Oligo]]/[[amenorrhea]] | ||
| | | | ||
* Hot flushes | * [[Hot flushes]] | ||
* Energy and mood changes | * Energy and mood changes | ||
* Decreased libido | * Decreased [[libido]] | ||
| | | | ||
* [[Breast tissue]] [[atrophy]] | |||
* Decreased [[maturation]] of [[vaginal]] [[mucosa]] | |||
| | | | ||
* Low estrogen, testosterone | * Low [[estrogen]], [[testosterone]] | ||
* High FSH/LH | * High [[FSH]]/[[Luteinizing hormone|LH]] | ||
| | | | ||
* [[FSH]] | |||
* [[Luteinizing hormone|LH]] | |||
| | | | ||
* Done to rule out any pituitary cause | * Done to rule out any [[pituitary]] cause | ||
| | | | ||
* Genetic tests ([[karyotype]]) | |||
* Genetic | * Measurement of total and free [[testosterone]] and [[17-Hydroxyprogesterone|17-hydroxyprogesterone]] concentrations | ||
* | |||
|- | |- | ||
!Hypoprolactinemia | |||
|Chronic | |Chronic | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| | | | ||
|Done to rule out any pituitary cause | * [[Infertility]] | ||
* Subfertiliy | |||
| | |||
* Puerperal agalactogenesis | |||
| | |||
* No workup is necessary | |||
| | |||
* Decreased [[prolactin]] levels | |||
| | |||
* Done to rule out any [[pituitary]] cause | |||
| | | | ||
* Prolactin assay in 3rd trimester | * [[Prolactin]] assay in [[3rd trimester]] | ||
* LH, FSH | * [[Luteinizing hormone|LH]], [[Follicle-stimulating hormone|FSH]] | ||
* Thyrotropin and free thyroxine | * [[Thyrotropin]] and free [[thyroxine]] | ||
|- | |- | ||
![[Panhypopituitarism]] | |||
|Chronic | |Chronic | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|Oligo/amenorrhea | |[[Oligomenorrhea|Oligo]]/[[amenorrhea]] | ||
| | | | ||
* Polyuria | * [[Polyuria]] | ||
* Polydipsia | * [[Polydipsia]] | ||
* Features of hypothyroidism and hypoadrenalism | * Features of [[hypothyroidism]] and [[hypoadrenalism]] | ||
| | | | ||
* Growth failure | * [[Growth failure]] | ||
* B/L hemianopsia | * B/L [[hemianopsia]] | ||
* Papilledema | * [[Papilledema]] | ||
|All pituitary hormones decreased | | | ||
|MRI | * All [[pituitary]] hormones decreased | ||
| | |||
* [[Magnetic resonance imaging|MRI]] | |||
| | |||
* Done to rule out any pituitary cause | |||
| | | | ||
* Left hand and wrist [[radiograph]] for [[bone age]] | |||
|- | |- | ||
![[Primary adrenal insufficiency]]/[[Addison's disease]] | |||
|Chronic | |Chronic | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
Line 275: | Line 281: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| | | | ||
* Hypoglycemia | * [[Hypoglycemia]] | ||
* Hypotension | * [[Hypotension]] | ||
| | | | ||
* Dehydration | * [[Dehydration]] | ||
* Hyperpigmentation | * [[Hyperpigmentation]] | ||
* loss of pubic and axillary hair | * loss of [[pubic]] and [[axillary]] hair | ||
| | | | ||
* Hyponatremia with/without hyperkalemia | * [[Hyponatremia]] with/without [[hyperkalemia]] | ||
* Plasma renin activity to aldosterone ratio | * [[Plasma renin activity]] to [[Aldosterone|aldosterone ratio]] | ||
| | | | ||
* Serum cortisol testing | * Abdominal [[Computed tomography|CT]] | ||
| | |||
* Abdominal [[Computed tomography|CT]] | |||
| | |||
* Serum [[cortisol]] testing | |||
* Serum ACTH testing | * Serum [[ACTH]] testing | ||
* Anti-adrenal Ab testing | * Anti-adrenal [[Antibody|Ab]] testing | ||
|- | |- | ||
![[Menopause]] | |||
|Chronic | |Chronic | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>+/-</nowiki> | |<nowiki>+/-</nowiki> | ||
| | |[[Oligomenorrhea|Oligo]]/[[amenorrhea]] | ||
|Oligo/amenorrhea | |||
| | | | ||
* [[Hot flashes]] | |||
* [[Insomnia]] | |||
* [[Weight gain]] and [[bloating]] | |||
* Mood changes | |||
| | | | ||
* [[Vaginal atrophy]] | |||
* Loss of pelvic [[muscle tone]] | |||
| | | | ||
* ↑ [[FSH]] | |||
* ↓ [[Estradiol]] and [[inhibin]] | |||
| | | | ||
* [[FSH]] > [[LH]] | |||
| | | | ||
* Normal | |||
| | | | ||
* [[Endometrial biopsy]] | |||
|} | |} | ||
</small> | |||
==References== | |||
{{Reflist|2}} | {{Reflist|2}} | ||
| |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Medicine]] | |||
[[Category:Endocrinology]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Obstetrics]] |
Latest revision as of 00:09, 30 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]
Overview
Sheehan's syndrome must be differentiated from other diseases causing hypopituitarism, such as lymphocytic hypophysitis, pituitary apoplexy, hypothyroidism, Addison's disease, panhypopituitarism, empty sella syndrome, hypogonadotropic hypogonadism, Simmonds' disease, hypoprolactinemia, and menopause.
Differentiating Sheehan's Syndrome from other Diseases
Sheehan's syndrome should be differentiated from other diseases causing hypopituitarism.[1][2][3][4][5][6][7]
Diseases | Onset | Manifestations | Diagnosis | |||||||
---|---|---|---|---|---|---|---|---|---|---|
History and Symptoms | Physical examination | Laboratory findings | Gold standard | Imaging | Other investigation findings | |||||
Trumatic delivery | Lactation failure | Menstrual irregularities | Other features | |||||||
Sheehan's syndrome | Acute | ++ | ++ | Oligo/amenorrhea | Symptoms of: |
|
|
CT/MRI:
|
| |
Lymphocytic hypophysitis | Acute | +/- | + | Oligo/amenorrhea |
|
|
|
Assays for:
| ||
Pituitary apoplexy | Acute | +/- | ++ | Oligo/amenorrhea | Severe headache
|
|
|
Blood tests may be done to check: | ||
Empty sella syndrome | Chronic | - | + | Oligo/amenorrhea |
|
|
|
|
| |
Simmonds' disease/Pituitary cachexia | Chronic | +/- | + | Oligo/amenorrhea |
|
|
|
| ||
Hypothyroidism | Chronic | +/- | - | Oligomenorrhea/menorrhagia |
|
|
|
|
|
|
Hypogonadotropic hypogonadism | Chronic | - | - | Oligo/amenorrhea |
|
|
|
|
| |
Hypoprolactinemia | Chronic | - | + | - |
|
|
|
|
|
|
Panhypopituitarism | Chronic | - | + | Oligo/amenorrhea |
|
|
|
|
| |
Primary adrenal insufficiency/Addison's disease | Chronic | - | - | - |
|
|
|
| ||
Menopause | Chronic | - | +/- | Oligo/amenorrhea |
|
|
|
References
- ↑ Sato N, Sze G, Endo K (1998). "Hypophysitis: endocrinologic and dynamic MR findings". AJNR Am J Neuroradiol. 19 (3): 439–44. PMID 9541295.
- ↑ Powrie JK, Powell M, Ayers AB, Lowy C, Sönksen PH (1995). "Lymphocytic adenohypophysitis: magnetic resonance imaging features of two new cases and a review of the literature". Clin. Endocrinol. (Oxf). 42 (3): 315–22. PMID 7758238.
- ↑ Honegger J, Schlaffer S, Menzel C, Droste M, Werner S, Elbelt U, Strasburger C, Störmann S, Küppers A, Streetz-van der Werf C, Deutschbein T, Stieg M, Rotermund R, Milian M, Petersenn S (2015). "Diagnosis of Primary Hypophysitis in Germany". J. Clin. Endocrinol. Metab. 100 (10): 3841–9. doi:10.1210/jc.2015-2152. PMID 26262437.
- ↑ Thodou E, Asa SL, Kontogeorgos G, Kovacs K, Horvath E, Ezzat S (1995). "Clinical case seminar: lymphocytic hypophysitis: clinicopathological findings". J. Clin. Endocrinol. Metab. 80 (8): 2302–11. doi:10.1210/jcem.80.8.7629223. PMID 7629223.
- ↑ Imura H, Nakao K, Shimatsu A, Ogawa Y, Sando T, Fujisawa I, Yamabe H (1993). "Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus". N. Engl. J. Med. 329 (10): 683–9. doi:10.1056/NEJM199309023291002. PMID 8345854.
- ↑ Hsieh CY, Liu BY, Yang YN, Yin WH, Young MS (2011). "Massive pericardial effusion with diastolic right ventricular compression secondary to hypothyroidism in a 73-year-old woman". Emerg Med Australas. 23 (3): 372–5. doi:10.1111/j.1742-6723.2011.01425.x. PMID 21668725.
- ↑ Dejager S, Gerber S, Foubert L, Turpin G (1998). "Sheehan's syndrome: differential diagnosis in the acute phase". J. Intern. Med. 244 (3): 261–6. PMID 9747750.