35 year old mother of two children is suffering from amenorrhea from last 12 month. She has a history of failure lactation following second delivery but remained asymptomatic thereafter. Skull X-ray shows empty sella diagnosis is :
Question Category:
Correct Answer:
Sheehan's syndrome
Description:
Ans. is c i.e. Sheehan's Syndrome Friends, here before arriving to any diagnosis lets first see the causes of : Empty Sella : Congenital incompleteness of the sellar diaphragm. Presentation : Women present with : * Galactorrheadeg Features of hypogonadism : Men present with : * Impotence Loss of libido Infeility. In both sexes they can cause : Cavernous sinus syndrome consisting Raised serum prolactin levels X-Ray sella shows space occupying lesion. Investigations : In all cases of hyperprolactinemia : - MRI should be performed - TSH levels should be measured. Management : Microadenoma with no desire of feility : Asymptomatic patients with microadenomas rarely progress to macroadenomas managed conservatinely. If patient has osteopenia. (due to hypoestrogenemia caused by TProlactin levels) estrogen replacement or OCP's. Monitor patients with regular serial prolactin levels and MRI (every 12 months). 216 * Secondary to Surgery / Radiotherapy or infarction of pituitary tumor. * Secondary to Infarction and Necrosisof pituitary gland. Now from the given causes : either pituitary tumor or Sheehans syndrome can cause an empty sells on x Ray. Pituitary Tumours (Micro / Macro adenoma) cause galactorrhoea (not lactationat failure) with amenorrhea and are so, ruled out. - So, the ObVious answer me by exclusion is Sheehan's Syndrome. Sheehan's syndro: It is the syndrome which results from ischaemic necrosis of most of the Anterior Pituitarydeg due to spasm in its aerioles occurring at the time of severe hemorrhage or shock complicatingchildbih. Only the anterior pituitary is affected because in paurient woman, blood supply to the pituitary gland is modified to the advantage of the posterior lobe and disadvantage of the anterior lobe so, when spasm occurs, posterior lobe is protected. When 75% of Anterior pituitary is destroyed, manifestations of Sheehan's syndrome appear and when 95% is destroyed -- fully developed Simmonds syndrome is seen. Hormones of Anterior Pituitary are affected in order of frequency = GH, FSH and LH, TSH and ACTH. Clinical Features : SymptomsQ Failure of lactation after deliverydeg Secondary amenorrhoeadeg Loss of libidodeg Increased sensitivity to cold (hypothydroidism)deg Signs : Absence of axillary sweatingdeg 1 Loss of axillary and pubic hairdeg Signs of adrenal coical failure Decrease in skin pigmentationdeg I Anemia due to lack of pituitary erythropoeitic factor Weakness, lethargydeg Hypothermiadeg Hypoglycemiadeg (due to decreased insulin tolerance)deg Hypothyroidismdeg All genital organs show atrophy, uterus is smaller than in postmenopausal womendeg as there is decrease in FSH, LH $ estrogen Although dormant ovaries retain their ova till menopausedeg Lab investigation : FSH LH TSH ACTH 1deg Oestrogens J.deg Urinary 17 keto steroids ,1,deg Management : The treatment of Sheehan's syndrome includes : Life long hormone substitute including estrogen,
Get More
Subject Mock Tests
Try practicing mock tests with over 200,000 questions from various medical subjects.
Attempt a mock test now