Inappropriate secretion of antidiuretic hormone in Sheehan's syndrome: a rare cause of postpartum hyponatremia

Article Abstract:

Sheehan's syndrome is an abnormality of the anterior pituitary gland that can occur in a woman who has recently delivered. It results when the woman hemorrhages after delivering and blood flow to the pituitary is diminished, resulting in tissue damage. This may then lead to hypopituitarism or low pituitary activity in a few cases. This study examined the case of a 27-year-old woman suffering from Sheehan's syndrome who developed hyponatremia, an abnormally low level of sodium in the blood. The patient had hemorrhaged right after delivering a healthy infant and went into shock. She was treated and recovered. Seven days later she complained of weakness and headache. Tests revealed she was suffering from hyponatremia. Computed tomographic scans of the brain showed abnormalities of her pituitary gland. The hyponatremia was found to be caused by inappropriate release of an antidiuretic hormone due to the damage to the pituitary that occurred when the patient hemorrhaged after delivering her baby. The patient was successfully treated with hydrocortisone. This case points out that hyponatremia that occurs in a female soon after she has delivered may be a result of hypopituitarism caused by Sheehan's syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of, Physiological aspects, Pregnancy, Complications of, Pregnancy complications, Hyponatremia, Endocrine gland diseases, Endocrine diseases

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Testing, testing, testing...

Article Abstract:

Physicians may perform too many diagnostic tests before beginning treatment, but they should only perform tests that can reveal something about the diagnosis. Various factors that contribute to excessive testing include fear of malpractice claims, pressure from patients, and the availability of technology. Physicians need to become more comfortable with uncertainty and appreciate that beginning a treatment is effectively a diagnostic test. How many tests a physician performs is related to the diagnosis they believe is most likely. A 55-year-old woman with arthritis had a rash, blood in her stools, an elevated CA-125 value, and high levels of eosinophils. Because he suspected a gastrointestinal tumor, her physician administered a battery of tests including bone marrow biopsies, gastrointestinal endoscopy, ultrasonography, and exploratory surgery. Another physician believed that the woman had hypereosinophilic syndrome and would have performed fewer tests and begun steroid treatment earlier. The woman did not have cancer and corticosteroid treatment was effective.

Methods, Diagnosis, Eosinophil disorders

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Lucky lady

Article Abstract:

A 24-year-old pregnant woman with a history of systemic lupus erythematosus was admitted to a hospital in her second trimester. She had severe leg swelling and large quantities of protein in her urine. Her doctors thought she had a lupus flare-up with kidney involvement and treated her accordingly. A few weeks later she developed difficulty breathing and fever. A chest X-ray revealed fluid in the lungs that was not relieved by furosemide (Lasix). Her lung function worsened and she was placed on a ventilator. A lung biopsy revealed Pneumocystis pneumonia and she was started on trimethoprim-sulfamethoxazole (Bactrim). She delivered a healthy, premature baby while she was in intensive care, but her white blood cell count dropped. The Bactrim was stopped and she was treated with inhaled pentamidine. She gradually improved and was discharged four months after admission.

Care and treatment, Drug therapy, Pneumocystis carinii pneumonia, Systemic lupus erythematosus, Agranulocytosis, Granulocytopenia

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