Tham khảo tài liệu 'phương pháp điều trị sản khoa - tình huống số 8', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 17 A 24-ycar-old Ỉ2 P2 woman delivered vaginally 8 months previously. Her delivery was complicated by postpartum hemorrhage requiring curettage of the uterus and a blood transfusion of two units of erythrocytes. She complains of amenorrhea since her delivery. She was not able to breast-feed her baby. She denies taking medications or having headaches or visual abnormalities. Her pregnancy test is negative. What is the most likely diagnosis What are other complications that are likely with this condition 152 CASH FILES OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 17 Amenorrhea Sheehan s Syndrome Summary A 24-year-old G2 P2 woman has had amenorrhea since a vaginal delivery complicated by postpartum hemorrhage and uterine curettage. She was not able to breast-feed after delivery and is not currently pregnant. Most likely diagnosis Sheehan s syndrome anterior pituitary necrosis . Other complications that are likely with this condition Anterior pituitary insufficiency such as hypothyroidism or adrenocortical insufficiency. Analysis Objectives 1. Be able to differentiate Sheehan s syndrome from intrauterine adhesions Asherman s syndrome . 2. Understand the mechanism of Sheehan s syndrome. 3. Know the other tropic hormones that may be affected by anterior pituitary necrosis. Considerations This patient developed amenorrhea from the time of her vaginal delivery that was complicated by postpartum hemorrhage. The initial evaluation should be a pregnancy test which is negative . The patient also underwent a uterine curettage in the treatment of the postpartum bleeding. In this setting there are two explanations 1 Sheehan s syndrome and 2 intrauterine adhesions Asherman s syndrome . Sheehan s syndrome is caused by hypotension in the postpartum period leading to hemorrhagic necrosis of the anterior pituitary gland. Asherman s syndrome is caused by the uterine curettage which damages the decidua basalis layer rendering the endometrium unresponsive. The key to dif CLINICAL CASLS
