Sheehan's syndrome physical examination: Difference between revisions

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Latest revision as of 00:09, 30 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Overview

Patients with Sheehan's syndrome usually appear fatigued, lethargic, and complain of recent weight gain. Physical examination is usually remarkable for bradycardia, hypotension, pallor, and signs suggestive of respective hormonal deficiency. Clinical features depend upon the severity of hypopituitarism.

Physical Examination

Clinical features depend upon the severity of hypopituitarism that results from Sheehan's syndrome. Almost all the patients have growth hormone (GH), prolactin, and gonadotropin deficiency; the majority has adrenocoticotropic hormone (ACTH) and thyroid stimulating hormone (TSH) deficiency.^[1]^[2]^[3]

Hypopituitarism	Presentation
Mild	Remains undiagnosed for many years
Less severe	Postpartum agalactorrhea and amenorrhea (week/months after delivery) Loss of sexual hair Mild degree of: fatigue Anorexia Weight loss
Severe	Lethargy Anorexia Weight loss Postpartum agalactorrhea (days/week after delivery)

Examination findings based upon specific hormonal deficiency

Hormonal deficiency	Finding
ACTH	Acute	Postural hypotension Tachycardia
ACTH	Chronic	Anorexia Weight loss No hyperpigmentation
TSH	Slow movement and slow speech Delayed relaxation of tendon reflexes Bradycardia Carotenemia Coarse skin Puffy faces and loss of eyebrows Periorbital edema Enlargement of the tongue Diastolic hypertension Pleural and pericardial effusions Ascites Galactorrhea
Gonadotropins	Breast atrophy Regression of sexual characteristics
Growth hormone	Decreased sweating and impaired thermogenesis Reduced muscle mass and strength Fine facial wrinkles Increased central obesity

Appearance of the Patient

Patients usually appear fatigued and lethargic and present with weight loss.

Vital Signs

Skin

HEENT

Fine wrinkling of face
Loss of eyebrows laterally

Genitourinary

Neuromuscular

Patient is usually oriented to time, place and person

Extremities

Pitting edema of the upper/lower extremities (myxedema)
Muscle wasting
Delayed relaxation of deep tendon reflexes

References

↑ Dökmetaş HS, Kilicli F, Korkmaz S, Yonem O (2006). "Characteristic features of 20 patients with Sheehan's syndrome". Gynecol. Endocrinol. 22 (5): 279–83. doi:10.1080/09513590600630504. PMID 16785150.
↑ Sert M, Tetiker T, Kirim S, Kocak M (2003). "Clinical report of 28 patients with Sheehan's syndrome". Endocr. J. 50 (3): 297–301. PMID 12940458.
↑ Keleştimur F (2003). "Sheehan's syndrome". Pituitary. 6 (4): 181–8. PMID 15237929.

Template:WH Template:WS

[pmid16785150-1] Dökmetaş HS, Kilicli F, Korkmaz S, Yonem O (2006). "Characteristic features of 20 patients with Sheehan's syndrome". Gynecol. Endocrinol. 22 (5): 279–83. doi:10.1080/09513590600630504. PMID 16785150.

[pmid12940458-2] Sert M, Tetiker T, Kirim S, Kocak M (2003). "Clinical report of 28 patients with Sheehan's syndrome". Endocr. J. 50 (3): 297–301. PMID 12940458.

[pmid15237929-3] Keleştimur F (2003). "Sheehan's syndrome". Pituitary. 6 (4): 181–8. PMID 15237929.

[1]

[2]

[3]

@@ Line 4: / Line 4: @@
 ==Overview==
-Patients with Sheehan's syndrome usually appear [[Fatigue|fatigued]], [[lethargic]] and [[weight gain]]. Physical examination is usually remarkable for [[bradycardia]], [[hypotension]], [[pallor]] and signs suggestive of  respective hormonal deficiency. Clinical features depend upon the severity of hypopitutarism that results
+Patients with Sheehan's syndrome usually appear [[Fatigue|fatigued]], [[lethargic]], and complain of recent [[weight gain]]. Physical examination is usually remarkable for [[bradycardia]], [[hypotension]], [[pallor]], and signs suggestive of respective hormonal deficiency. Clinical features depend upon the severity of [[hypopituitarism]].
 ==Physical Examination==
+Clinical features depend upon the severity of [[hypopituitarism]] that results from Sheehan's syndrome. Almost all the patients have [[GH|growth hormone (GH)]], [[prolactin]], and [[gonadotropin]] deficiency; the majority has [[Adrenocorticotropic hormone|adrenocoticotropic hormone (ACTH)]] and [[TSH|thyroid stimulating hormone (TSH)]] deficiency.<ref name="pmid16785150">{{cite journal |vauthors=Dökmetaş HS, Kilicli F, Korkmaz S, Yonem O |title=Characteristic features of 20 patients with Sheehan's syndrome |journal=Gynecol. Endocrinol. |volume=22 |issue=5 |pages=279–83 |year=2006 |pmid=16785150 |doi=10.1080/09513590600630504 |url=}}</ref><ref name="pmid12940458">{{cite journal |vauthors=Sert M, Tetiker T, Kirim S, Kocak M |title=Clinical report of 28 patients with Sheehan's syndrome |journal=Endocr. J. |volume=50 |issue=3 |pages=297–301 |year=2003 |pmid=12940458 |doi= |url=}}</ref><ref name="pmid15237929">{{cite journal |vauthors=Keleştimur F |title=Sheehan's syndrome |journal=Pituitary |volume=6 |issue=4 |pages=181–8 |year=2003 |pmid=15237929 |doi= |url=}}</ref>
 {| class="wikitable"
 !Hypopituitarism
 !Presentation
 |-
-|Mild
+|'''Mild'''
-|Remains undiagnosed for many years
+|
+* Remains undiagnosed for many years
 |-
-|Less severe
+|'''Less severe'''
 |
-* Postpartum agalactorrhea and amenorrhea (week/months after delivery
+* [[Postpartum]] agalactorrhea and [[amenorrhea]] (week/months after delivery)
 * Loss of sexual hair
-* Mild degree of
+* Mild degree of:
-** fatigue
+** [[fatigue]]
-** Anorexia
+** [[Anorexia]]
-** Weight loss
+** [[Weight loss]]
 |-
-|Severe
+|'''Severe'''
 |
-* Lethargy
+* [[Lethargy]]
-* Anorexia
+* [[Anorexia]]
-* Weight loss
+* [[Weight loss]]
-* Postpartum agalactorrhea (days/week after delivery)
+* [[Postpartum]] agalactorrhea (days/week after delivery)
 |}
+== Examination findings based upon specific hormonal deficiency ==
+{| class="wikitable"
+!Hormonal deficiency
+! colspan="2" |Finding
+|-
+| rowspan="2" |[[Adrenocorticotropic hormone|ACTH]]
+|Acute
+|
+* [[Postural hypotension]]
+* [[Tachycardia]]
+|-
+|Chronic
+|
+* [[Anorexia]]
+* [[Weight loss]]
+* No [[hyperpigmentation]]
+|-
+|[[TSH]]
+| colspan="2" |
+* Slow movement and slow speech
+* Delayed [[relaxation]] of [[Tendon reflex|tendon reflexes]]
+* [[Bradycardia]]
+* [[Carotenemia]]
+* Coarse [[skin]]
+* Puffy faces and loss of [[eyebrows]]
+* [[Periorbital edema]]
+* [[Macroglossia|Enlargement of the tongue]]
+* Diastolic [[hypertension]]
+* [[Pleural Effusion|Pleural]] and [[Pericardial effusion|pericardial effusions]]
+* [[Ascites]]
+* [[Galactorrhea]]
+|-
+|[[Gonadotropins]]
+| colspan="2" |
+* [[Breast]] atrophy
+* Regression of [[sexual characteristics]]
+|-
+|[[Growth hormone]]
+| colspan="2" |
+* Decreased [[sweating]] and impaired [[thermogenesis]]
+* Reduced [[muscle mass]] and strength
+* Fine facial [[Wrinkle|wrinkles]]
+* Increased central [[obesity]]
+|}
 ===Appearance of the Patient===
-*Patients usually appear [[Fatigue|fatigued]] and [[lethargic]]
+*Patients usually appear [[Fatigue|fatigued]] and [[lethargic]] and present with weight loss.
 ===Vital Signs===
@@ Line 63: / Line 120: @@
 ==References==
 {{Reflist|2}}
 {{WH}}
 {{WS}}
+[[Category:Medicine]]
+[[Category:Endocrinology]]
+[[Category:Up-To-Date]]
+[[Category:Emergency medicine]]
+[[Category:Obstetrics]]