Sheehan's syndrome differential diagnosis: Difference between revisions
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* Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests) | * Pituitary hormone stimulation tests ([[Metoclopramide]] and [[clomiphene citrate]] stimulation tests) | ||
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![[Primary hypothyroidism]] | ! [[Primary hypothyroidism|Hypothyroidism]] | ||
|Chronic | |Chronic | ||
|<nowiki>+/-</nowiki> | |<nowiki>+/-</nowiki> | ||
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* Low [[T3]],[[T4]] | * Low [[T3]],[[T4]] | ||
* | * Normal/ low [[Thyroid-stimulating hormone|TSH]] | ||
* Rest of pituitary hormone levels WNL | * Rest of pituitary hormone levels WNL | ||
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*FNA biopsy | *FNA biopsy | ||
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! | ![[Hypogonadotropic hypogonadism]] | ||
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* [[Breast tissue]] [[atrophy]] | * [[Breast tissue]] [[atrophy]] | ||
* Decreased [[maturation]] of [[vaginal]] [[mucosa]] | * Decreased [[maturation]] of [[vaginal]] [[mucosa]] | ||
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* Low [[estrogen]], [[testosterone]] | * Low [[estrogen]], [[testosterone]] | ||
* High [[FSH]]/[[LH]] | * High [[FSH]]/[[Luteinizing hormone|LH]] | ||
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* [[FSH]] | |||
* [[Luteinizing hormone|LH]] | |||
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* Done to rule out any pituitary cause | * Done to rule out any pituitary cause | ||
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* [[Magnetic resonance imaging|MRI]] | * [[Magnetic resonance imaging|MRI]] | ||
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* Done to rule out any pituitary cause | |||
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* Left hand and wrist [[radiograph]] for [[bone age]] | * Left hand and wrist [[radiograph]] for [[bone age]] | ||
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* [[FSH]] > [[LH]] | * [[FSH]] > [[LH]] | ||
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* [[Endometrial biopsy]] | |||
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Revision as of 18:20, 14 September 2017
Sheehan's syndrome Microchapters |
Diagnosis |
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Treatment |
Case Studies |
Sheehan's syndrome differential diagnosis On the Web |
American Roentgen Ray Society Images of Sheehan's syndrome differential diagnosis |
Risk calculators and risk factors for Sheehan's syndrome differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]
Overview
Sheehan's syndrome must be differentiated from other diseases causing hypopituitarism such as lymphocytic hypophysitis, pituitary apoplexy, hypothyroidism, Addison's disease, panhypopituitarism, empty sella syndrome, hypogonadotropic hypogonadism, Simmonds' disease, hypoprolactinemia, and menopause.
Differentiating Sheehan's Syndrome from other Diseases
Sheehan's syndrome should be differentiated from other diseases causing hypopituitarism.[1][2][3][4][5][6][7]
Diseases | Onset | Manifestations | Diagnosis | |||||||
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History and Symptoms | Physical examination | Laboratory findings | Gold standard | Imaging | Other investigation findings | |||||
Trumatic delivery | Lactation failure | Menstrual irregularities | Other features | |||||||
Sheehan's syndrome | Acute | ++ | ++ | Oligo/amenorrhea | Symptoms of: |
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CT/MRI:
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Lymphocytic hypophysitis | Acute | +/- | + | Oligo/amenorrhea |
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Assays for:
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Pituitary apoplexy | Acute | +/- | ++ | Oligo/amenorrhea | Severe headache
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Blood tests may be done to check: | ||
Empty sella syndrome | Chronic | - | + | Oligo/amenorrhea |
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Simmonds' disease/Pituitary cachexia | Chronic | +/- | + | Oligo/amenorrhea |
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Hypothyroidism | Chronic | +/- | - | Oligomenorrhea/menorrhagia |
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Hypogonadotropic hypogonadism | Chronic | - | - | Oligo/amenorrhea |
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Hypoprolactinemia | Chronic | - | + | - |
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Panhypopituitarism | Chronic | - | + | Oligo/amenorrhea |
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Primary adrenal insufficiency/Addison's disease | Chronic | - | - | - |
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Menopause | Chronic | - | +/- | Oligo/amenorrhea |
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Normal |
References
- ↑ Sato N, Sze G, Endo K (1998). "Hypophysitis: endocrinologic and dynamic MR findings". AJNR Am J Neuroradiol. 19 (3): 439–44. PMID 9541295.
- ↑ Powrie JK, Powell M, Ayers AB, Lowy C, Sönksen PH (1995). "Lymphocytic adenohypophysitis: magnetic resonance imaging features of two new cases and a review of the literature". Clin. Endocrinol. (Oxf). 42 (3): 315–22. PMID 7758238.
- ↑ Honegger J, Schlaffer S, Menzel C, Droste M, Werner S, Elbelt U, Strasburger C, Störmann S, Küppers A, Streetz-van der Werf C, Deutschbein T, Stieg M, Rotermund R, Milian M, Petersenn S (2015). "Diagnosis of Primary Hypophysitis in Germany". J. Clin. Endocrinol. Metab. 100 (10): 3841–9. doi:10.1210/jc.2015-2152. PMID 26262437.
- ↑ Thodou E, Asa SL, Kontogeorgos G, Kovacs K, Horvath E, Ezzat S (1995). "Clinical case seminar: lymphocytic hypophysitis: clinicopathological findings". J. Clin. Endocrinol. Metab. 80 (8): 2302–11. doi:10.1210/jcem.80.8.7629223. PMID 7629223.
- ↑ Imura H, Nakao K, Shimatsu A, Ogawa Y, Sando T, Fujisawa I, Yamabe H (1993). "Lymphocytic infundibuloneurohypophysitis as a cause of central diabetes insipidus". N. Engl. J. Med. 329 (10): 683–9. doi:10.1056/NEJM199309023291002. PMID 8345854.
- ↑ Hsieh CY, Liu BY, Yang YN, Yin WH, Young MS (2011). "Massive pericardial effusion with diastolic right ventricular compression secondary to hypothyroidism in a 73-year-old woman". Emerg Med Australas. 23 (3): 372–5. doi:10.1111/j.1742-6723.2011.01425.x. PMID 21668725.
- ↑ Dejager S, Gerber S, Foubert L, Turpin G (1998). "Sheehan's syndrome: differential diagnosis in the acute phase". J. Intern. Med. 244 (3): 261–6. PMID 9747750.