Sheehan综合征并低钠血症临床分析

Clinical characteristics of Sheehan syndrome with hyponatremia

目的探讨Sheehan综合征并低钠血症的临床特点和诊治原则。方法对30例Sheehan综合征患者的临床表现、实验室结果、治疗方法等临床资料进行分析。结果30例患者中17例有低钠血症,占57%。与血钠正常者比较,低血钠患者年龄较大(P<0.05),临床发生恶心、呕吐和意识障碍较多见(P<0.05),但血皮质醇水平和ACTH水平差异并无显著性(P>0.05)。发生垂体危象11例,与无危象组比较,前者血皮质醇较低(P<0.05),但年龄、血钠和ACTH水平两组间比较差异均无显著性(P>0.05)。出现垂体危象者及时给予糖皮质激素替代治疗非常有效。结论Sheehan综合征常合并低钠血症,特别是老年人,易出现恶心呕吐、意识障碍,在应激情况下易发生垂体危象。对Sheehan综合征并发的低钠血症给予糖皮质激素配合补充钠盐治疗非常有效。治疗中血钠水平上升不能过快,以免出现渗透性脑桥脱髓鞘病变及持久的神经损害,谨慎的监测血钠是必须的。

[Objective] To summarize the clinical characteristic and the principle of diacrisis and therapy of Sheehan syndrome with hyponatremia. [Methods] In a retrospective study we screened the clinical records of 30 patients with Sheehan syndrome （17 eases with hypenatremia ,11 cases with pituitary crisis）. The pathogenesis, clinical symptom, diagnosis and treatment of Sheehan syndrome with hypenatremia were discussed. [Results] Seventeen patients （57%） have hypenatremia. The patients with hyponatremia were older than those with normal natremia （P 〈 0.05）, and often show nausea vomiting and conscious disturbance. The levels of ACTH and hydroeortisone were not different significantly between the two groups. 11 patients who developed hypopituitary crisis have a lower level of hydroeortisone comparing with those without hypopituitary crisis （P 〈0.05）. [Condusions] Sheehan syndrome often combines with hyponatremia, especially in the older. The patients with hyponatremia often show nausea and vomiting and conscious disturbance and sometimes develop pituitary crisis. Treatment with hydrocortisone and sodium chloride is very effective on these patients. Rapid correction of chronic hyponatremia may lead to the development of osmotic myelinolysis.