急性胰腺炎合并席汉氏综合征：1例病例报道并文献复习

doi:10.24920/003574

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The authors successfully treated a case of Sheehan's syndrome accompanied by acute pancreatitis. Patients with this disease usually manifest symptoms of severe acute pancreatitis even when no pancreatic necrosis appears or necrosis is slight on CT scan. Therefore, for women with high triglycerides type acute pancreatitis, primary hypothyroidism or secondary hypothyroidism induced by Sheehan's syndrome should be excluded first.

Abstract

A 44-year-old woman was transferred to the ICU of the First Affiliated Hospital of Jinan University for 2 days of persistent epigastric pain and 7 hours of unconsciousness. Her admission diagnosis was severe acute necrotizing pancreatitis (hypertriglyceridemia type) with multiple organ dysfunctions. The results of CT revealed a small area of necrotizing pancreatitis, which was not consistent with the severe clinical manifestations. Considering lack of hair and history of postpartum hemorrhage, hormone examination was carried out. According to the results of the examination, she was further diagnosed as Sheehan’s syndrome and pituitary crisis. After hormone replacement therapy, her condition improved rapidly.

Key words: acute pancreatitis, Sheehan's syndrome, pituitary crisis, hypertriglyceridemia

Liu Dasheng, Liu Li, Gan Feng, Wu Xianlin, Ye Gang. Acute Pancreatitis Complicated by Sheehan's Syndrome: A Case Report and Literature Review[J].Chinese Medical Sciences Journal, 2020, 35(1): 95-100.

Figures/Tables 2

References 28.

1.	Zhang WZ, Xie JX, Shen J , et al. Hypertriglyceridemic acute pancreatitis in a patient with Sheehan’s syndrome. Hepatobiliary Pancreat Dis Int 2006; 5(3):468-70.
2.	He FQ, Huang ZW, Guo J , et al. Severe acute pancreatitis in a patient with Sheehan’s syndrome. Chin J Criti Care Medi 2007; 27(1):762-3.
3.	Shen DH, Sun GB, Luo R , et al. Sheehan’s syndrome with severe acute pancreatitis: a case report. Practical J Med Pharm 2013; 30(2):127.
4.	Zhen ZQ, Yang XW . Characteristic features of acute pancreatitis with Sheehan’s syndrome. Chin J Endocr Surg 2013; 7(6):515-6. doi: 10.3760/cma.j.issn.1674-6090.2013.06.020.
5.	Chen YQ, Feng CL . Sheehan’s syndrome with acute pancreatitis: a case report. Chongqing Medical 2017; 46(16):2591-2.
6.	Sheehan HL . Postpartum necrosis of the anterior pituitary. J Pathol Bact 1937; 45(7):189-214. doi: 10.1002/path.1700450118.
7.	Kristjansdottir HL, Bodvarsdottir SP, Sigurjonsdottir HA . Sheehan’s syndrome in modern times: a nationwide retrospective study in Iceland. Eur J Endocrinol 2011; 164(3):349-54. doi: 10.1530/EJE-10-1004.
8.	Diri H, Karaca Z, Tanriverdi F , et al. Sheehan’s syndrome: new insights into an old disease. Endocrine 2016; 1(1):22-31. doi: 10.1007/s12020-015-0726-3.
9.	Dharmshaktu P, Bhowmick J, Manglani D , et al. Recurrent symptomatic hypoglycaemia with pancytopenia as a delayed presentation of Sheehan’s syndrome with complete recovery after hormone replacement. BMJ Case Rep 2013; 21(11):9014. doi: 10.1136/bcr-2013-009014.
10.	Sanyal D, Raychaudhuri M . Varied presentations of Sheehan’s syndrome at diagnosis: a review of 18 patients. Indian J Endocrinol Metab 2012; 16(Suppl 2):S300-1. doi: 10.4103/2230-8210.104067.
11.	Leonidas H, Gabriela B . A renewed focus on the association between thyroid hormones and lipid metabolism. Front Endocrinol (Lausanne) 2018; 9(3):511-20. doi: 10.3389/fendo.2018.00511.
12.	Lam KS, Chan MK, Yeung RT . High-density lipoprotein cholesterol, hepatic lipase and lipoprotein lipase activitiesin thyroid dysfunction—effects of treatment. Q J Med 1986; 59(229):513-21. doi: 10.1016/0091-7435(86)90051-4.
13.	Arikan S, Bahceci M, Tuzcu A , et al. Postprandial hyperlipidemia in overt and subclinical hypothyroidism. Eur J Intern Med 2012; 23:e141-5. doi: 10.1016/j.ejim.2012.05.007.
14.	McGowan A, Widdowson WM, O’Regan A , et al. Postprandial studies uncover differing effects on HDL particles of overt and subclinical hypothyroidism. Thyroid 2016; 26(3):356-64. doi: 10.1089/thy.2015.0443
15.	Scherer J, Singh VP, Pitchumoni CS , et al. Issues in hypertriglyceridemic pancreatitis—an update. J Clin Gastroenterol 2014; 48(3):195-203. doi: 10.1097/01.mcg.0000436438.60145.5a.
16.	Inayat F, Zafar F, Baig AS . Hypertriglyceridemic pancreatitis treated with insulin therapy: a comparative review of 34 cases. Cureus 2018; 10(10):e3501. doi: 10.7759/cureus.3501.
17.	Syed H, Bilusic M, Rhondla C , et al. Plasmapheresis in the treatment of hypertriglyceridemia-induced pancreatitis: a community hospital’s experience. J Clin Apher 2010; 25(4):229-34. doi: 10.1002/jca.20232.
18.	Navina S, Acharya C, DeLany JP , et al. Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity. Sci Transl Med 2011; 3(107):107-10. doi: 10.1126/scitranslmed.3002573.
19.	Shahnaz AM, Shariq RM, Arshad IW , et al. Deep vein thrombosis in a patient of Sheehan’s syndrome: autoimmunity or hypercoagulabilty. Indian J Endocrinol Metab 2013; 17(Suppl1):S105-6. doi: 10.4103/2230-8210.
20.	Tanriverdi F, Gül A, Gül I , et al. Massive cardiac thrombosis in a patient with Sheehan’s syndrome. Endocr J 2005; 52(6):709-14. doi: 10.1507/endocrj.52.709.
21.	Carr RA, Rejowski BJ, Cote GA , et al. Systematic review of hypertriglyceridemia-induced acute pancreatitis: a more virulent etiology? Pancreatology 2016; 16(4):469-76. doi: 10.1016/j.pan.2016.02.011.
22.	Samarasinghe S, Avari P, Meeran K , et al. Management of hypertriglyceridaemic pancreatitis in the acute setting and review of literature. BMJ Case Rep 2018; 11(1):e227594. doi: 10.1136/bcr-2018-227594.
23.	Kandemir A, Coşkun A, Yavaşoğlu İ , et al. Therapeutic plasma exchange for hypertriglyceridemia induced acut pancreatitis: the 33 cases experience from a tertiary reference center in Turkey. Turk J Gastroenterol 2018; 29(6):676-83. doi: 10.5152/tjg.2018.17627.
24.	Stefanutti C, Labbadia G, Morozzi C . Severe hypertriglyceridemia-related acute pancreatitis. Ther Apher Dial 2013; 17(2):130-7. doi: 10.1111/1744-9987.
25.	Valdivielso P, Ramírez-Bueno A, Ewald N . Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med 2014; 25(8):689-94. doi: 10.1016/j.ejim.2014.08.008.
26.	Song X, Shi D, Cui Q , et al. Intensive insulin therapy versus plasmapheresis in the management of hypertriglyceridemia-induced acute pancreatitis (Bi-TPAI trial): study protocol for a randomized controlled trial. Trials 2019; 20(1):365-71. doi: 10.1186/s13063-019-3498-x.
27.	Inayat F, Zafar F, Riaz I , et al. Hypertriglyceridemic pancreatitis: is insulin monotherapy a feasible therapeutic option? Cureus 2018; 10(10):e3461. doi: 10.7759/cureus.3461.
28.	Diri1 H, Karaca1 Z, Tanriverdi1 F , et al. Sheehan’s syndrome: new insights into an old disease. Endocrine 2016; 51(1):22-31. doi: 10.1007/s12020-015-0726-3.

Items	Zhang et al.^[1]	He et al.^[2]	Shen et al.^[3]	Zhen et al.^[4]	Chen et al.^[5]
Year of publication	2006	2006	2011	2011	2017
Age (yrs)	32	50	52	48	40
Time of menopause (yrs)	7	25	24	25	9
Blood pressure (mm Hg)	78/50	60/20	80/60	80/55	135/82
Amylase (U/L)	301	284	361	630	87.9
Pancretic necrosis	-	+	+	-	-
Calcium (mmol/L)	1.79	1.34	unavailable	2.4	1.87
Sodium (mmol/L)	unavailable	129.4	unavailable	125	135.9
Potassium (mmol/L)	unavailable	unavailable	unavailable	3.4	3.90
Glucose (mmol/L)	unavailable	13.6	unavailable	11.6	10.0
FT3 (pmol/L)	unavailable	31.62	0.4	1.22	1.49
FT4 (pmol/L)	unavailable	2.69	0.75	8.0	2.53
TSH (µIU/ml)	unavailable	normal	0.972	normal	normal
Estrogen	unavailable	decrease	normal	decrease	decrease
Cortisol	unavailable	decrease	unavailable	normal	normal
Triglyceride (mmol/L)	29.06	12.77	unavailable	unavailable	unavailable
Hormone deficiency	estrogen	thyroid, progesterone, cortisol	thyroid hormone	thyroid, progesterone, estrogen	thyroid, estrogen
HRT	estrogen	stop HRT	stop HRT	no	no

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Acute Pancreatitis Complicated by Sheehan's Syndrome: A Case Report and Literature Review

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