postpartum pituitary necrosis
Introduction
Introduction Psilotype anterior hypofunction (also known as Sheehan's disease) is caused by a variety of lesions in the pituitary or hypothalamus involving the endocrine function of the pituitary. When all or most of the pituitary is destroyed, a series of manifestations of endocrine glandular dysfunction can occur, with the main glands involved being the gonads, thyroid, and adrenal cortex. The disease is more common in women, and is associated with pituitary avascular necrosis caused by postpartum hemorrhage.
Cause
Cause
Modern medicine believes that the most common causes of this disease are postpartum hemorrhage, pituitary and hypothalamic tumors, infection, craniocerebral trauma, head and neck radiation therapy, pituitary resection, systemic diseases such as leukemia, lymphoma, malnutrition, nervous system dysfunction Wait. The clinical manifestations of anterior pituitary dysfunction are related to the extent of pituitary failure, the type of hormone involved, the degree of pressure increase in the sella and the site of pituitary damage, the age of onset and the sex of the patient.
Examine
an examination
Related inspection
Endocrine function test obstetric B-ultrasound
The various hormones secreted by the pituitary gland (such as gonadotropin, thyrotropin, and adrenocorticotropic hormone) are reduced, and the cause and performance can be confirmed. The clinical manifestations of anterior pituitary dysfunction are related to the extent of pituitary failure, the type of hormone involved, the degree of pressure increase in the sella and the site of pituitary damage, the age of onset and the sex of the patient.
Diagnosis
Differential diagnosis
Differential diagnosis of postpartum pituitary necrosis:
1, pituitary dysfunction: anterior pituitary dysfunction is caused by the lack of secretion of hormones in the pituitary gland. The disease can be divided into partial and complete categories, the former involved only one to two hormones; the latter is the synthesis and secretion of all anterior pituitary hormones. The clinical manifestations mainly depend on the type and extent of anterior pituitary hormone deficiency; in addition, the age of onset also affects clinical manifestations.
2, pituitary crisis: pituitary crisis and pituitary apoplexy, clinically known as pituitary crisis. When the function of the anterior pituitary is reduced, the adrenal cortex hormone and thyroid hormone are deficient, the body's stress ability is decreased, and the crisis is induced by infection, vomiting, diarrhea, dehydration, cold, hunger, and the application of sleeping pills or anesthetics. Pituitary tumor sudden intratumoral hemorrhage, infarction, necrosis, tumor expansion, causing acute neuroendocrine lesions called pituitary apoplexy.
The clinical manifestations of anterior pituitary dysfunction are related to the extent of pituitary failure, the type of hormone involved, the degree of pressure increase in the sella and the site of pituitary damage, the age of onset and the sex of the patient.
Some of the pituitary dysfunction is more common than all pituitary dysfunction. The order of secretion is generally preceded by luteinizing hormone (LH) and GH, followed by follicle stimulating hormone (FSH), ACTH, thyroid stimulating hormone (TSH), and finally vasopressin (VP). Lack of prolactin (PRL) secretion is less common, except for pituitary necrosis after delivery.
Hyperprolactinemia may be due to tumors (such as prolactin tumors), but more commonly due to dysfunction of the hypothalamus, increased secretion of PRL in normal glands. In patients with hypothalamic lesions, diabetes insipidus is more common, and when hypothalamic-pituitary lesions are sufficient to impair ACTH secretion, the polyuria symptoms of diabetes collapse can be relieved and concealed. Undiminished anterior pituitary dysfunction is sensitive to various stresses such as infection, surgery, anesthesia, alcoholism, etc. The specific performance is:
1, the woman's palace body shrinks, the perineum and vaginal mucosa atrophy, often accompanied by vaginitis. Sex hormone secretion reduces postpartum no milk, breast atrophy and vulva, uterus atrophy, long-term amenorrhea, pubic hair, hair thinning off.
2, thyroxine reduction, pale, dry skin and desquamation. Less luster and elasticity, hair, eyebrows sparse, loss of appetite, severe mucous edema, indifferent performance, mental disorders, often constipation, cold and obesity.
3, adrenocortical hormone reduction, fatigue, nausea, vomiting, weak heart sounds, slow heart rate, weak pulse, low blood pressure, severe hypoglycemia; skin color is shallow, susceptible to infection.
4, pituitary hypoplasia crisis, severe weakness, nausea and vomiting; high fever (high fever type) or body temperature below 35 ° C (low temperature type), hypoglycemia (hypoglycemia type), low blood pressure or shock (hypotension type ); convulsions and coma in severe cases.
