SIMMONDS-SHIEN (SHEEHAN SYNDROME) PANHYPOPITUITARISM

Аннотация

In embolism, tuberculosis, and ulcerative diseases of the hypothalamic- pituitary system, patients with damage (necrosis) of the anterior pituitary gland experience cachexia, atrophy of internal organs, and decreased function of the gonads. As the disease progresses, the patient's general condition worsens. Keywords: brain, portal system, disease, muscle, pituitary gland. Pangipopituitarism is a lesion of the hypothalamic-pituitary system, characterized by decreased pituitary function and insufficiency of peripheral endocrine glands. This syndrome includes two diseases: Simmonds' disease and Sheehan's disease. Simmonds' disease is a severe degree of insufficiency of the hypothalamic-pituitary system, the main cause of which is pituitary necrosis, characterized by cachexia and polyendocrine insufficiency. The disease occurs more often in women. Sheehan's disease (postpartum panhypopituitarism) is a hypothalamic-pituitary insufficiency that occurs in women after massive hemorrhage during childbirth or, rarely, septic conditions. ETIOLOGY: The main causes of Schieden's disease 1. Massive postpartum hemorrhage (more than 1 liter), collapse, severe septic conditions leading to septic embolism of the veins of the pituitary portal system 2. Frequent and repeated pregnancies 3. Severe toxicosis in the second half of pregnancy Simmonds' disease occurs in both women and men, and its causes are as follows 1. Infectious-inflammatory processes in the hypothalamic-pituitary zone 2. Cerebral circulatory disorders of various genesis, which injure the hypothalamic- pituitary zone 3. Brain injuries 4. Radiation therapy in the hypothalamic-pituitary zone 5. Surgical operations on the hypothalamic-pituitary zone (hypophysectomy) 6. Primary and metastatic tumors 7. In the hypothalamic-pituitary zone diseases that cause destructive processes: tuberculosis, malaria, syphilis, sarcoidosis 8. Severe bleeding of various etiologies (gastrointestinal, uterine, renal, etc. bleeding) 9. Unknown etiology (idiopathic) PATHOGENESIS: Massive bleeding and septic embolism lead to impaired blood circulation in the pituitary gland, spasm of the pituitary portal system, hypoxia, necrosis and complete or partial decrease in pituitary function, as well as the development of secondary insufficiency of the function of many endocrine glands (polyglandular endocrine insufficiency) - adrenal glands, gonads and thyroid glands. When the neurohypophysis or pituitary stalk is involved, diabetes insipidus is also added to the process. 1100 ResearchBib IF - 11.01, ISSN: 3030-3753, Volume 2 Issue 5 In Schein's disease, sometimes the symptoms may be less pronounced and a certain function of the adenohypophysis may be impaired, for example, only secondary hypothyroidism or secondary adrenal insufficiency may be observed. CLINICAL: The clinical manifestations of Simmonds' and Schein's diseases are similar, but in Simmonds' disease, the first thing that occurs is progressive weight loss, with a loss of 3-6 kg of body weight per month, resulting in cachexia (pituitary cachexia). Appetite is suddenly reduced or absent, patients eat very little food or refuse to eat. Weight loss is uniform throughout the body, and the subcutaneous fat layer is lost uniformly everywhere. In Schein's disease, weight loss is less pronounced. Objective: the skin is dry, flaky, flaky, yellowish-white, the hair turns gray and falls out early and quickly, the face is wrinkled, the teeth fall out. Premature aging quickly develops. General weakness, apathy, adynamia, fainting, collapses are observed. Hypothalamo-pituitary cachexia, postpartum hypopituitarism - is characterized by widespread destructive changes in the adenohypophysis and the diencephalon, resulting in partial or complete deficiency of all hormones of the adenohypophysis. The disease most often occurs in women aged 30-40 years. Historical data: the disease was first described in 1913 by Glinsky and in 1914 by Simmonds. The fact that the disease develops after massive postpartum hemorrhage was first described by Sheehan in 1939. ETIOLOGY: 1) hemorrhages, especially massive postpartum hemorrhages (more than 1 liter) 2) tumors of the hypothalamic-pituitary system 3) infectious processes in the hypothalamic-pituitary system (syphilis, tuberculosis, influenza, typhus, etc.) 4) hemorrhages in the adenohypophysis after head trauma 5) hypophysectomies 6) acute necrosis of the adenohypophysis as a result of arteriolar spasm due to massive blood loss during childbirth and abortion 7) septic embolism of the adenohypophysis vessels PATHOGENESIS: Due to destructive changes in the hypothalamus and adenohypophysis, there is a deficiency in the secretion of all hormones produced by the anterior pituitary gland. As a result, peripheral glands often have a decrease in the function of the thyroid gland, adrenal cortex, and gonads. Low production of GH leads to atrophic processes in organs and tissues. CLINICAL: patients develop weakness, apathy,