Palabras clave
síndrome de Sheehan
necrosis hipofisiaria posparto
enfermedades raras
hemorragia posparto
amenorrea
silla turca vacía
lactancia fallida
hipoglicemia
hiponatremia
Cómo citar
Resumen
Contexto: el síndrome de Sheehan es una de las causas del hipopituitarismo y se presenta cuando hay una necrosis hipofisiaria posparto debido al shock hipovolémico que resulta de una hemorragia masiva.
Objetivo: conseguir información sobre nuevos enfoques diagnósticos y terapéuticos en países desarrollados sobre datos históricos, manifestaciones clínicas, diagnóstico, etiopatogenia, epidemiología, tratamiento y pronóstico del síndrome de Sheehan.
Metodología: para elaborar esta revisión narrativa, se hizo una búsqueda de la literatura en las bases de datos de PubMed, Google Scholar, Lilacs y Scielo, utilizando los términos anotados como palabras clave y la revisión del listado de referencias (en “bola de nieve”) de los estudios seleccionados.
Resultados: las series más grandes provinieron de países como India y China, y algunas de América Latina, aunque también hubo otras provenientes de países desarrollados. Las originadas en África no mostraron el problema real, ya que muchos pacientes morían sin ir al hospital o permanecían bajo el manejo de chamanes. Al momento del diagnóstico, la clínica suele ser florida. Solo hubo un estudio en la India que exploró la prevalencia; además, hubo series menos grandes, pero con casos bien estudiados y con tecnología actual. En los países desarrollados se hizo prevención, dando la mejor atención obstétrica posible, donde el diagnóstico diferencial se hizo entre hipopituitarismo, manifestaciones psiquiátricas, hiponatremia, hipoglicemia severa, diabetes insípida, problemas de coagulación o de autoinmunidad, además de la presencia clínica de las clásicas deficiencias hormonales, actuando rápido en los pocos y frecuentes casos agudos. Se observó la divulgación de casos clínicos con alguna característica especial.
Conclusiones: el síndrome de Sheehan es poco frecuente, pero se puede ver en algunas mujeres con historia de hemorragia masiva posparto. El diagnóstico a menudo se hace tardíamente y los pacientes tienen deficiencia hormonal sintomática, por lo que se les debe dar terapia de suplencia, con el fin de mejorar la calidad de vida y evitar un potencial riesgo de muerte.
Citas
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