Sheehan's syndrome laboratory findings

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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

Lab evaluation gives a picture of partial or panhypopituitarism and laboratory findings consistent with the diagnosis of Sheehan's syndrome include hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, hypophosphatemia, anemia, pancytopenia, eosinophilia, hypoalbuminemia and low fasting plasma glucose. The most sensitive test is inadequate prolactin and gonadotropin responses to stimulation.

Laboratory findings consistent with the diagnosis of Sheehan syndrome include:
- Hyponatremia^[1]^[2]^[3]
- Hypokalemia
- Hypocalcemia
- Hypomagnesemia
- Hypophosphatemia
- Anemia^[3]
- Pancytopenia^[4]
- Eosinophilia^[5]
- Hypoalbuminemia
- Low fasting plasma glucose
- Elevated serum SGOT
- Thrombocytopenia
- Decreased levels of anterior pituitary hormones in blood
  - Low free thyroxine
  - Low estradiol
  - Decreased cortisol levels
Most sensitive test is inadequate prolactin and gonadotropin responses to stimulation
ACTH stimulation test is done after 3 months postpartum as adrenal gland takes 3 months to get atrophied in absence of ACTH stimulation. During this 3 month period, definitive diagnosis of ACTH and GH deficiency can be made by other stimulation tests such as insulin induced hypoglycemia or glucagon. etc

↑ Shoji M, Kimura T, Ota K, Ohta M, Sato K, Yamamoto T, Funyu T, Mori T, Tateyama M, Abe K (1996). "Cortical laminar necrosis and central pontine myelinolysis in a patient with Sheehan syndrome and severe hyponatremia". Intern. Med. 35 (5): 427–31. PMID 8797063.
↑ Putterman C, Almog Y, Caraco Y, Gross DJ, Ben-Chetrit E (1991). "Inappropriate secretion of antidiuretic hormone in Sheehan's syndrome: a rare cause of postpartum hyponatremia". Am. J. Obstet. Gynecol. 165 (5 Pt 1): 1330–3. PMID 1957856.
↑ ^3.0 ^3.1 Anfuso S, Patrelli TS, Soncini E, Chiodera P, Fadda GM, Nardelli GB (2009). "A case report of Sheehan's syndrome with acute onset, hyponatremia and severe anemia". Acta Biomed. 80 (1): 73–6. PMID 19705625.
↑ Laway BA, Bhat JR, Mir SA, Khan RS, Lone MI, Zargar AH (2010). "Sheehan's syndrome with pancytopenia--complete recovery after hormone replacement (case series with review)". Ann. Hematol. 89 (3): 305–8. doi:10.1007/s00277-009-0804-9. PMID 19697029.
↑ Ratarasarn C, Rajatanavin R, Himathongkam T (1989). "Salient clinical features of Sheehan's syndrome". J Med Assoc Thai. 72 (1): 41–7. PMID 2723566.