Sheehan’s Pituitary Infarction

Fig. 64.1

Sheehan’s infarction. (a) Sagittal T1-weighted precontrast MR image. (b) Coronal T1-weighted gadolinium-enhanced image. (c) Sagittal T1-weighted precontrast image. (d) Sagittal T1-weighted gadolinium-enhanced image. The pituitary gland is markedly thinned (a, b) compared with 1 year earlier, when the patient presented with acute endocrinopathy and necrosis within the normal-size pituitary gland (d)

In some cases, prolapse of the optic chiasm into an empty sella may be seen [17].

In acute stage, the pituitary gland demonstrates diffuse central hypoenhancement on MRI, indicating infarction.

64.3 Histopathology

Sheehan’s syndrome is characterized microscopically by extensive necrosis of the pituitary gland and fibrous scar formation.
Atrophy of the pituitary gland is often seen on autopsy studies.
Normal adenohypophyseal cells may be replaced with scar formation, ghost cells, necrotic debris, an inflammatory infiltrate, collagen scar formation, and chronic blood products [10].

64.4 Clinical Management

Clinical management in patients with suspected pituitary infarction relies on timely diagnosis and hormonal replacement.
Acute and severe hypocortisolemia is an uncommon but life-threatening aspect of this condition; rapid replacement of the cortisol axis is imperative.
Many patients will require hormonal replacement for multiple anterior pituitary hormonal axes and potentially desmopressin acetate (DDAVP) to treat diabetes insipidus.
Growth hormone replacement may be beneficial in patients with Sheehan’s syndrome [18].

References

Kelestimur F. Sheehan’s syndrome. Pituitary. 2003;6:181–8.CrossRefPubMed

Tun-Pe, Phillips RE, Warrell DA, Moore RA, Tin-Nu-Swe, Myint-Lwin, Burke CW. Acute and chronic pituitary failure resembling Sheehan’s syndrome following bites by Russell’s viper in Burma. Lancet. 1987;2(8562):763–7.

Zayour DH, Azar ST. Silent pituitary infarction after coronary artery bypass grafting procedure: case report and review of literature. Endocr Pract. 2006;12:59–62.CrossRefPubMed

Jones NS, Finer N. Pituitary infarction and development of the empty sella syndrome after gastrointestinal haemorrhage. Br Med J (Clin Res Ed). 1984;289:661–2.CrossRef

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