CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 5, September/October 2022 280 AFRICA Discussion Sheehan’s syndrome is a pituitary dysfunction disease induced by severe postpartum haemorrhage, particularly in the presence of prolonged hypovolaemic shock. Harold L Sheehan was the first to describe it in 1937. In the 1960s, it affected 100 to 200 per million people. The incidence of the disease is declining worldwide and is now one of several rare causes of hypopituitarism in developed countries.1 However, due to the lack of good postpartum haemorrhage management and poor obstetric care in developing countries, this is still a major cause of hypopituitarism. The typical manifestations include long-term weakness and fatigue, lactation failure at first and then secondary amenorrhea, loss of genital and axillary hair, dry and rough skin and other manifestations of hypopituitarism. Laboratory results commonly reveal hyponatraemia, anaemia and hypoglycaemia. Other electrolyte disturbances are also observed in patients with Sheehan’s syndrome. The diagnosis of Sheehan’s syndrome is mostly retrospective and replacement of deficient hormones is the basic principle of therapy. The mortality rate of untreated Sheehan’s syndrome is 2.7 times that of the general population.2 Although cardiac complications of Sheehan’s syndrome have previously been reported, such as congestive heart failure and reversible dilated cardiomyopathy,3 associated reports of life-threatening arrhythmias are relatively rare. For the literature review, we used articles published in English for the manual search. In previous medical literature, eight cases with Sheehan’s syndrome were reported to have ventricular tachycardia as the main manifestation.4-10 The data of cases regarding epidemiology, laboratory examinations, treatment and outcomes are summarised in Table 1. The mean age was 46 years (interquartile range: 33 to 63 years). At admission, the most common laboratory abnormality was hypokalaemia (62.5%), followed by hypoglycaemia (37.5%) and hypomagnesaemia (25%). Subsequently, pituitary dysfunction with hypothyroidism was seen in 75%, adrenal insufficiency in 75%, FSH deficiency in (37.5%), LH deficiency in 25% and prolactin deficiency in 50% of patients. At presentation, 75% of cases presented with QT-interval prolongation, four (50%) with polymorphic ventricular tachycardia, two (25%) with ventricular fibrillation, one (12.5%) with monomorphic ventricular tachycardia, and one patient (12.5%) with TdP. In terms of treatment, hormone replacement was the most common therapeutic method. All of the patients were Table 1. Clinical summary of the eight cases of Sheehan’s syndrome with ventricular tachycardia Study Age Hypokalaemia Hypoglycaemia Hypomagnaesemia Hypothyroidism Cortisol ACTH Sex hormone Hormone deficiency QT prolongation Diagnosis Treatment Outcome Shinde et al. 2017 35 Yes NA No Yes Decrease Decrease Normal Thyroid, cortisol, ACTH Yes PMVT Potassium, levothyroxine, hydrocortisone Well Komuro et al. 2016 63 No NA No No Decrease Decrease Decrease Cortisol, ACTH, FSH, LH, prolactin Yes PMVT Hydrocortisone, temporary pacemaker Well Cao et al. 2014 62 Yes Yes NA Yes Normal Normal Normal Thyroid No VF Glucose, glucocorticoid, levothyroxine Well Masood et al. 2014 45 No No No Yes Decrease Normal Decrease Thyroid, cortisol, prolactin Yes TdP Thyroxine, hydrocortisone, temporary pacemaker Died from cardiac arrest 35 Yes Yes Yes Yes Normal Normal Decrease Thyroid, FSH, prolactin Yes MVT Hydrocortisone, temporary pacemaker, oestrogen, progesterone Well Wang et al. 2005 33 No No No Yes Decrease Decrease Decrease Thyroid, ACTH, cortisol, FSH, LH, prolactin, oestradiol Yes PMVT Thyroxine, hydrocortisone Well Shoji et al. 1996 58 Yes NA NA Yes Normal Decrease Normal Thyroid, ACTH No VF Hydrocortisone, hypertonic saline Well Nunoda et al. 1989 40 Yes Yes Yes No Decrease Normal Normal Cortisol Yes PMVT Cortisone Well ACTH: adrenocorticotropic hormone; FSH: follicle-stimulating hormone; LH: luteinising hormone; PMVT: polymorphic ventricular tachycardia; VF: ventricular fibrillation; TdP: torsade de pointes; MVT: monomorphic ventricular tachycardia; NA: not available. Fig. 5. Cerebral CT showed empty sella (red arrow).
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