The Use of Cortisone in the Treatment of the Panhypopituitarism Due to Postpartum Necrosis of the Pituitary (Sheehan’s Syndrome)

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IN a series of articles, the first of which was published in 1914, Simmonds1–3 described destruction of the anterior lobe of the pituitary gland and its clinical effects. This condition became known as Simmonds’ disease.

Knowledge of this disease has been greatly broadened by the work of Sheehan,4,5 who, in 1937, first described areas of pituitary infarction and fibrosis due to thrombosis with necrosis occurring in women having a history of severe postpartum hemorrhage accompanied by shock and usually coma. The anterior pituitary failure which results from this type of lesion is usually, but not always, more extensive than that produced by other types of lesions of the pituitary. If the gonadotropins, thyrotropin and corticotropin are all absent, the condition is termed “panhypopituitarism,” despite the fact that the function of the posterior lobe is not known to be unimpaired. If the secretion of only one or two of these hormones is deficient, the condition may be termed “selective” or “partial” pituitary failure.

Thus, the symptoms and signs of the panhypopituitarism of Sheehan’s syndrome are largely due to the effects of secondary atrophy and failure of the adrenal cortices, the thyroid and the ovaries. Most of these symptoms, signs and laboratory findings are described in the following two case studies.

The main purpose of this paper is to discuss the use of cortisone or hydro-cortisone in the treatment of the adrenal cortical failure that occurs secondary to severe anterior pituitary failure.


Case 1. A 33 year old white . . .



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