Sheehan's syndrome physical examination: Difference between revisions
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==Physical Examination== | ==Physical Examination== | ||
Clinical features depend upon the severity of [[hypopituitarism]] that results from Sheehan's syndrome. Almost all the patients have [[GH]], [[prolactin]], and [[gonadotropin]] deficiency; the majority has [[ACTH]] and [[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> | 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" | {| class="wikitable" | ||
!Hypopituitarism | !Hypopituitarism | ||
!Presentation | !Presentation | ||
|- | |- | ||
|Mild | |'''Mild''' | ||
| | | | ||
* Remains undiagnosed for many years | * Remains undiagnosed for many years | ||
|- | |- | ||
|Less severe | |'''Less severe''' | ||
| | | | ||
* Postpartum agalactorrhea and [[amenorrhea]] (week/months after delivery) | * [[Postpartum]] agalactorrhea and [[amenorrhea]] (week/months after delivery) | ||
* Loss of sexual hair | * Loss of sexual hair | ||
* Mild degree of: | * Mild degree of: | ||
| Line 25: | Line 25: | ||
** [[Weight loss]] | ** [[Weight loss]] | ||
|- | |- | ||
|Severe | |'''Severe''' | ||
| | | | ||
* [[Lethargy]] | * [[Lethargy]] | ||
* [[Anorexia]] | * [[Anorexia]] | ||
* [[Weight loss]] | * [[Weight loss]] | ||
* Postpartum agalactorrhea (days/week after delivery) | * [[Postpartum]] agalactorrhea (days/week after delivery) | ||
|} | |} | ||
| Line 38: | Line 38: | ||
! colspan="2" |Finding | ! colspan="2" |Finding | ||
|- | |- | ||
| rowspan="2" |ACTH | | rowspan="2" |[[Adrenocorticotropic hormone|ACTH]] | ||
|Acute | |Acute | ||
| | | | ||
| Line 50: | Line 50: | ||
* No [[hyperpigmentation]] | * No [[hyperpigmentation]] | ||
|- | |- | ||
|TSH | |[[TSH]] | ||
| colspan="2" | | | colspan="2" | | ||
* Slow movement and slow speech | * Slow movement and slow speech | ||
| Line 76: | Line 76: | ||
* [[Galactorrhea]] | * [[Galactorrhea]] | ||
|- | |- | ||
|Gonadotropins | |[[Gonadotropins]] | ||
| colspan="2" | | | colspan="2" | | ||
* Breast atrophy | * [[Breast]] atrophy | ||
* Regression of [[sexual characteristics]] | * Regression of [[sexual characteristics]] | ||
|- | |- | ||
|Growth hormone | |[[Growth hormone]] | ||
| colspan="2" | | | colspan="2" | | ||
* Decreased [[sweating]] and impaired [[thermogenesis]] | * Decreased [[sweating]] and impaired [[thermogenesis]] | ||
* Reduced [[muscle mass]] and strength | * Reduced [[muscle mass]] and strength | ||
* Fine facial wrinkles | * Fine facial [[Wrinkle|wrinkles]] | ||
* Increased central [[obesity]] | * Increased central [[obesity]] | ||
|} | |} | ||
Revision as of 18:20, 12 October 2017
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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 |
|
| Less severe |
|
| Severe |
|
Examination findings based upon specific hormonal deficiency
| Hormonal deficiency | Finding | |
|---|---|---|
| ACTH | Acute | |
| Chronic | ||
| TSH |
| |
| Gonadotropins |
| |
| Growth hormone |
| |
Appearance of the Patient
Vital Signs
Skin
- Pallor
- Areolar Hypopigmentation
- Coarse and dry skin
- Hair loss
HEENT
Genitourinary
Neuromuscular
- Patient is usually oriented to time, place and person
Extremities
- Pitting edema of the upper/lower extremities (myxedema)
- Muscle wasting
- Delayed relaxation of deep tendon reflexes
References
- ↑ 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.
- ↑ 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.
- ↑ Keleştimur F (2003). "Sheehan's syndrome". Pituitary. 6 (4): 181–8. PMID 15237929.