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__NOTOC__
__NOTOC__
{{Sheehan's syndrome}}
{{Sheehan's syndrome}}
{{CMG}}; {{AE}}  
{{CMG}}; {{AE}}{{IQ}}  


==Overview==
==Overview==
*Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Patients with Sheehan's syndrome usually appear [[Fatigue|fatigued]], [[lethargic]], and complain of recent [[weight gain]]. Physical examination is usually remarkable for [[bradycardia]], [[hypotension]], [[pallor]], and signs suggestive of respective hormonal deficiency. Clinical features depend upon the severity of [[hypopituitarism]].
*Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
==Physical Examination==
==Physical Examination==
Clinical features depend upon the severity of [[hypopituitarism]] that results from Sheehan's syndrome. Almost all the patients have [[GH|growth hormone (GH)]], [[prolactin]], and [[gonadotropin]] deficiency; the majority has [[Adrenocorticotropic hormone|adrenocoticotropic hormone (ACTH)]] and [[TSH|thyroid stimulating hormone (TSH)]] deficiency.<ref name="pmid16785150">{{cite journal |vauthors=Dökmetaş HS, Kilicli F, Korkmaz S, Yonem O |title=Characteristic features of 20 patients with Sheehan's syndrome |journal=Gynecol. Endocrinol. |volume=22 |issue=5 |pages=279–83 |year=2006 |pmid=16785150 |doi=10.1080/09513590600630504 |url=}}</ref><ref name="pmid12940458">{{cite journal |vauthors=Sert M, Tetiker T, Kirim S, Kocak M |title=Clinical report of 28 patients with Sheehan's syndrome |journal=Endocr. J. |volume=50 |issue=3 |pages=297–301 |year=2003 |pmid=12940458 |doi= |url=}}</ref><ref name="pmid15237929">{{cite journal |vauthors=Keleştimur F |title=Sheehan's syndrome |journal=Pituitary |volume=6 |issue=4 |pages=181–8 |year=2003 |pmid=15237929 |doi= |url=}}</ref>
{| class="wikitable"
!Hypopituitarism
!Presentation
|-
|'''Mild'''
|
* Remains undiagnosed for many years
|-
|'''Less severe'''
|
* [[Postpartum]] agalactorrhea and [[amenorrhea]] (week/months after delivery)
* Loss of sexual hair
* Mild degree of:
** [[fatigue]]
** [[Anorexia]]
** [[Weight loss]]
|-
|'''Severe'''
|
* [[Lethargy]]
* [[Anorexia]]
* [[Weight loss]]
* [[Postpartum]] agalactorrhea (days/week after delivery)
|}
== Examination findings based upon specific hormonal deficiency ==
{| class="wikitable"
!Hormonal deficiency
! colspan="2" |Finding
|-
| rowspan="2" |[[Adrenocorticotropic hormone|ACTH]]
|Acute
|
* [[Postural hypotension]]
* [[Tachycardia]]
|-
|Chronic
|
* [[Anorexia]]
* [[Weight loss]]
* No [[hyperpigmentation]]
|-
|[[TSH]]
| colspan="2" |
* Slow movement and slow speech
* Delayed [[relaxation]] of [[Tendon reflex|tendon reflexes]]


*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
* [[Bradycardia]]
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
* [[Carotenemia]]
*Patients with [disease name] usually appear [general appearance].
 
* Coarse [[skin]]


===Vital Signs===
* Puffy faces and loss of [[eyebrows]]
*Bradycardia


===Skin===
* [[Periorbital edema]]
*[[Cyanosis]]  
*[[Jaundice]]
* [[Pallor]]
* Bruises


<gallery widths=150px>
* [[Macroglossia|Enlargement of the tongue]]


UploadedImage-01.jpg | Description {{dermref}}
* Diastolic [[hypertension]]
UploadedImage-02.jpg | Description {{dermref}}


</gallery>
* [[Pleural Effusion|Pleural]] and [[Pericardial effusion|pericardial effusions]]


===HEENT===
* [[Ascites]]
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accomodation / non-reactive to neither light nor accomodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae / tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
* [[Galactorrhea]]
*[[Jugular venous distension]]
|-
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
|[[Gonadotropins]]
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
| colspan="2" |
*[[Thyromegaly]] / thyroid nodules
* [[Breast]] atrophy
*[[Hepatojugular reflux]]
* Regression of [[sexual characteristics]]
|-
|[[Growth hormone]]
| colspan="2" |
* Decreased [[sweating]] and impaired [[thermogenesis]]
* Reduced [[muscle mass]] and strength
* Fine facial [[Wrinkle|wrinkles]]
* Increased central [[obesity]]
|}


===Lungs===
===Appearance of the Patient===
* Asymmetric chest expansion / Decreased chest expansion
*Patients usually appear [[Fatigue|fatigued]] and [[lethargic]] and present with weight loss.
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Vital Signs===
*Chest tenderness upon palpation
*[[Bradycardia]]
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Orthostatic hypotension]]
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope


===Abdomen===
===Skin===
*[[Abdominal distention]]  
*[[Pallor]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Areolar]] [[Hypopigmentation]]
*[[Rebound tenderness]] (positive Blumberg sign)
*Coarse and [[dry skin]]
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*[[Hair loss]]
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===HEENT===
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Fine [[Wrinkle|wrinkling]] of face
*Sacral edema
*Loss of [[eyebrows]] [[Lateral|laterally]]
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
*A pelvic/adnexal mass may be palpated
*[[Breast tissue]] [[atrophy]]/[[Involutional melancholia|involution]]
*Inflamed mucosa
*[[Vaginal atrophy]]
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
*Patient is usually oriented to time, place and person
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
=== '''Extremities''' ===
*[[Clubbing]]
*[[Pitting edema]] of the upper/lower extremities ([[myxedema]])
*[[Cyanosis]]
*[[Muscle wasting]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Delayed relaxation of deep tendon reflexes
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==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

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Overview

Patients with Sheehan's syndrome usually appear fatigued, lethargic, and complain of recent weight gain. Physical examination is usually remarkable for bradycardia, hypotension, pallor, and signs suggestive of respective hormonal deficiency. Clinical features depend upon the severity of hypopituitarism.

Physical Examination

Clinical features depend upon the severity of hypopituitarism that results from Sheehan's syndrome. Almost all the patients have growth hormone (GH), prolactin, and gonadotropin deficiency; the majority has adrenocoticotropic hormone (ACTH) and thyroid stimulating hormone (TSH) deficiency.[1][2][3]

Hypopituitarism Presentation
Mild
  • Remains undiagnosed for many years
Less severe
Severe

Examination findings based upon specific hormonal deficiency

Hormonal deficiency Finding
ACTH Acute
Chronic
TSH
  • Slow movement and slow speech
Gonadotropins
Growth hormone

Appearance of the Patient

Vital Signs

Skin

HEENT

Genitourinary

Neuromuscular

  • Patient is usually oriented to time, place and person

Extremities

References

  1. ↑ Dökmetaş HS, Kilicli F, Korkmaz S, Yonem O (2006). "Characteristic features of 20 patients with Sheehan's syndrome". Gynecol. Endocrinol. 22 (5): 279–83. doi:10.1080/09513590600630504. PMID 16785150.
  2. ↑ Sert M, Tetiker T, Kirim S, Kocak M (2003). "Clinical report of 28 patients with Sheehan's syndrome". Endocr. J. 50 (3): 297–301. PMID 12940458.
  3. ↑ Keleştimur F (2003). "Sheehan's syndrome". Pituitary. 6 (4): 181–8. PMID 15237929.

​ Template:WH Template:WS

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