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At a glance

Hypopituitarism resulting from an infarct of the pituitary gland. Damage to the anterior portion of the pituitary gland causes partial or complete loss of thyroid, adrenocorticoid, and gonadal functions. Pituitary gland infarct following postpartum hemorrhage is better known as Sheehan Syndrome.

Synonyms

Glinski-Simmonds Syndrome; Simmonds Cachexia; Hypopituitarism Syndrome; Panhypopituitarism Syndrome; Pituitary Cachexia.

History

Maurice Simmonds, a German physician, described a female patient with chronic pituitary failure following puerperal sepsis in 1914. However, postpartum hypopituitarism is now better known as Sheehan Syndrome whereas all other pituitary failures are known as Simmonds Syndrome.

Incidence

Can occur in both sexes but more prevalent in females. The onset usually occurs in the postpubertal period.

Pathophysiology

Hypofunction and atrophy of the anterior pituitary gland can be observed with tumors, infections, surgery, or radiotherapy; occasionally idiopathic; associated with secondary atrophy of the thyroid gland, adrenal glands, and the gonads.

Clinical aspects

Asthenia and weight loss, atrophy of all body tissues; loss of body hair, atrophic skin; genital organ atrophy, loss of libido and potency; hypothermia sensitive; bradycardia and severe postural hypotension; psychic changes are all characteristic of this medical condition.

Diagnosis

History and clinical features; biochemical (low levels of T3, T4, thyroid-stimulating hormone, adrenocorticotropic hormone [ACTH], and gonadotropins); anemia; low basal metabolic rate; radiology (pituitary tumor demonstrated by CT scan of brain).

Anesthetic considerations

Preoperative replacement therapy should be undertaken because dramatic improvement can be expected; in the untreated case, the patient will be bradycardic and hemodynamically unstable perioperatively. Slow clearance of drugs renders the patient sensitive to effects of most drugs, including anesthetic drugs, opioids, and neuromuscular blockers; prone to hypothermia intraoperatively.

Pharmacological implications

Careful titration of doses of intravenous anesthetic drugs, including barbiturate and opioids, must be done to avoid hypotension. Hydrocortisone cover before, during, and after anesthesia is essential.

Other condition to be considered

  • Sheehan Syndrome: Hypopituitarism resulting from an infarct of the pituitary gland following postpartum shock or hemorrhage. Damage to the anterior portion of the pituitary gland causes partial or complete loss of thyroid, adrenocorticoid, and gonadal functions.

References

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Birch  CA: Simmonds disease. Morris Simmonds 1855-1925. Practitioner 212(1271):737, 1974.  [PubMed: 4618348]
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Diri  H, Karaca  Z, Tanriverdi  F,  et al: Sheehan’s syndrome: New insights into an old disease. Endocrine 51:22–31, 2016.  [PubMed: 26323346]
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Kilicli  F, Dokmetas  HS, Acibucu  F: Sheehan’s syndrome. Gynecol Endocrinol 29:292, 2013.  [PubMed: 23245206]
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Simmonds Syndrome. in Magalini SL, Magalini SC (eds) Dictionary of Medical Syndromes, 4th Ed. LIppincott-Williams-Wilkins. New York, USA, 1996, p ...

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