Sheehan's syndrome

[thehundredthone]

UWorld says Sheehan's syndrome is not a form of apoplexy? This is contrary to what I've read and been taught. I'm aware there are some authors that consider it a separate entity, so am I to do the same, for the USMLE's sake?

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[Ronin786]

According to Pathoma, Sheehan's is due to the pituitary enlarging in size during pregnancy without a subsequent increase in blood flow. So when there's post partum hemorrhage then the pituitary is susceptible and infarction occurs.

So if by apoplexy you mean bleeding into the Pituitary then I don't think it would be.

 

[thehundredthone]

I don't have my Davidson at hand, I lent it out to someone, but as far as I remember we were taught that apoplexy is acute pituitary insufficiency due to haemorrhage/infarction.

Medscape says:

The word apoplexy is defined as a sudden neurologic impairment, usually due to a vascular process. Pituitary apoplexy is characterized by a sudden onset of headache, visual symptoms, altered mental status, and hormonal dysfunction due to acute hemorrhage or infarction of a pituitary gland.

Wiki says:

Pituitary apoplexy is regarded by some as distinct from Sheehan's syndrome, where the pituitary undergoes infarction as a result of prolonged very low blood pressure, particularly when caused by bleeding after childbirth. This condition usually occurs in the absence of a tumor. Others regard Sheehan's syndrome as a form of pituitary apoplexy.

Anyway, so I'll make a note that for the exam, Sheehan's syndrome and pituitary apoplexy are completely different.

 

[ijn]

You're more likely to see pituitary apoplexy in a patient with a history of a pituitary micro/macroadenoma and suddenly **** hits the fan. Sheehan's is going to have a temporal relationship to pregnancy.

 

[thehundredthone]

The setting of Sheehan's I know, but I had a question on UWorld about Sheehan's and the answer choices included both ischaemic necrosis and apoplexy (obviously, ischaemic necrosis was the answer) and it was the first time I had seen Sheehan's not being considered as a form of apoplexy. Thanks though.

 

[Phloston]

More important than Sheehan's being ischaemic and apoplexy being haemorrhagic, is being able to identify apoplexy and not confusing it with a subarachnoid haemorrhage of the anterior communicating artery adjacent the optic chiasm. Upon haemorrhage, both can present with "the worst headache of my life," and before haemorrhage, visual problems can occur in both. The big key difference is prolactinaemia Sxs, since growing prolactinoma is a major cause of apoplexy.

 

[vc7777]

For what it is worth, i just so happened to open my OBGYN lange case files book which describes it specifically as a bleed resulting in a "pressure necrosis" today. I suspect it isn't a simple answer, or probably completely understood beyond the association.

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[thehundredthone]

The big key difference is prolactinaemia Sxs, since growing prolactinoma is a major cause of apoplexy.

That's weird considering most adenomas are asymptomatic, but that's the USMLE for you I guess.

I suspect it isn't a simple answer, or probably completely understood beyond the association.

What is, in medicine? Thanks for looking that up though. I guess I'll have to just cement this new factoid into memory until I'm done with the exam(s).

 

[vc7777]

What is, in medicine? Thanks for looking that up though. I guess I'll have to just cement this new factoid into memory until I'm done with the exam(s).

truism.

No problem. I should introduce myself as well.

I'm vc7777. I'm one of the new moderators, along with acronymallergy for the USMLE forums.
I've been an assistant moderator over in the nontraditional forum for a while before this. I arm just wrapping up my first rotation in obgyn and peds here in Cleveland. I took step one in June, so feel free to ask away. My school has no grades, exams, or rankings. So step one has been my only test so far and I studies pretty intensely for our! You can imagine I took it pretty seriously. Anyway, good luck studying folks!



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[Phloston]

truism.

No problem. I should introduce myself as well.

I'm vc7777. I'm one of the new moderators, along with acronymallergy for the USMLE forums.
I've been an assistant moderator over in the nontraditional forum for a while before this. I arm just wrapping up my first rotation in obgyn and peds here in Cleveland. I took step one in June, so feel free to ask away. My school has no grades, exams, or rankings. So step one has been my only test so far and I studies pretty intensely for our! You can imagine I took it pretty seriously. Anyway, good luck studying folks!

What did you score on Step1, and what advice do you have?

 

[vc7777]

I did well enough I have lots of advice. What in particular do you wasn't to know?

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