có khả năng đe dọa mạng sống của bệnh, biểu hiện lâm sàng là một trong những của một bệnh nhân bị bệnh với triệu chứng và dấu hiệu suy thượng thận: hạ huyết áp, nhịp tim nhanh, hạ đường huyết, mệt mỏi cùng cực, và buồn nôn và nôn mửa. Cũng được xem là không để mọc lại | EXTERNAL CAUSES OF METABOLIC DISORDERS 837 potentially life-threatening form of the disease the clinical presentation is one of an ill patient with symptoms and signs of adrenal insufficiency hypotension tachycardia hypoglycemia extreme fatigue and nausea and vomiting. Also seen are failure to regrow shaved pubic hair apathy and failure to lactate 30 . One should consider this diagnosis in obstetrical patients with severe hemorrhage not responsive to blood replacement and prolonged hypotension. This disease may be seen by emergency physicians because of shorter postpartum hospitalizations. In the chronic form the clinical presentation may be seen from weeks to years after delivery. The degree of hormone deficiency determines the clinical presentation. The syndrome may be subclinical in some patients and manifest only if the patient is stressed. Signs and symptoms may be vague and nonspecific lightheadedness fatigue failure to lactate persistent amenorrhea decreased body hair dry skin loss of libido nausea and vomiting and cold intolerance. DI has been reported in several cases of Sheehan s syndrome 8 38 . Pathophysiology The pituitary gland lies in the sella turcica within the sphenoid bone 32 . The pituitary normally enlarges during pregnancy. The gland is comprised of an anterior and posterior lobe which are anatomically distinct 33 . The blood supply to the anterior pituitary is through the internal carotid arteries and superior hypophyseal arteries. The inferior hypophyseal arteries supply the blood to the posterior pituitary. The anterior pituitary gland produces six major hormones prolactin PRL growth hormone GH corticotropin ACTH luteinizing hormone LH follicle stimulating hormone FSH and thyroid stimulating hormone TSH . The posterior pituitary gland produces ADH and oxytocin. The pathogenesis of Sheehan s syndrome is not understood fully. During pregnancy the normal pituitary enlarges predominantly because of progressive lactotroph hyperplasia. Based on .
