119例席汉综合征患者临床特征的回顾性分析

Clinical characteristics of 119 patients with Sheehan's syndrome :a retrospective study

目的 :探讨119例席汉综合征患者的临床特征。方法 :收集2002年1月~2014年11月在中南大学湘雅二医院内分泌科确诊为席汉综合征的119例住院患者的临床资料。结果 :119例席汉综合征患者中,确诊平均年限为(18.1±11.0)年。确诊席汉综合征患者再孕12例(10%),其中长期接受激素替代6例(5%),再孕后病情缓解1例(0.8%)。并发垂体危象64例(54%),以垂体危象为首发症状者48例(75%),无垂体危象55例(46%)。促性腺激素减退症为101例(97%),促甲状腺激素减退症占103例(89%),促肾上腺皮质激素减退症占51例(100%)。尿崩症3例(3%)。49例行垂体MRI,其中,空泡蝶鞍27例(55%),垂体萎缩19例(39%)。40例行骨密度检查,骨质疏松10例(25%),低骨量23例(58%)。结论 :席汉综合征的病情轻重不一,临床表现存在多样性,早期正确诊断至关重要。一方面诊断后及时靶腺激素替代治疗可避免垂体危象、骨质疏松症等的发生,另一方面病情轻者有可能再孕,再孕后病情可改善或缓解。

Objective To determine the clinical characteristics of 119 patients with Sheehan`s Syndrome(SS). Methods We collected the clinical data of 119 inpatients diagnosed of SS in Department of Endocrinology, the Second Xiangya Hospital, Central South University from January 2002 to November 2014. Results The mean period of diagnostic delay was(15.1±11)years in these 119 patients with SS. 12(10%) patients were pregnant again after being diagnosed with SS, 6(5%)of which have long-term hormone replacement therapy, 1(0.8%) of which were pregnant again Get better. 64(54%) developed pituitary crisis and 55(46%) did not, 48(75%)were pituitary crisis as first symptoms. 34(28.5%)had panhypopituitarism, while 85(71.5%)had partial hypopituitarism. 101(97%)of the patients had gonadotropin deficiency, while 103(89%)of the patients had TSH deficiency, and 51(100%)of the patients had ACTH deficiency. diabetes insipidus were 3 case(3%). In 49 subjects having magnetic resonance imaging of pituitary, 27(55%) showed empty sella and 19(39%) showed pituitary involution. Moreover, 40 subjects had bone mineral density examination, 10(25%) of which showed osteoporosis and 23(58%) of which showed osteopenia. Conclusion Sheehan’s syndrome of severe situation is different, clinical manifestations are diverse, early correct diagnosis is crucial. on the one hand, Prompt diagnosis and timely target gland hormone treatment can avoid pituitary crisis, osteoporosis, etc, on the other hand, Sheehan’s syndrome of slight cases may be pregnant again, pregnant again after the SS can be improved or alleviated.