scholarly journals Etiopathogenesis of Sheehan’s Syndrome: Roles of Coagulation Factors and TNF-Alpha

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Halit Diri ◽  
Elif Funda Sener ◽  
Fahri Bayram ◽  
Nazife Tascioglu ◽  
Yasin Simsek ◽  
...  
Keyword(s):  
Gene Polymorphisms ◽  
Venous Blood ◽  
Hormone Deficiency ◽  
Control Group ◽  
Pituitary Hormone ◽  
Factor V ◽  
Sheehan’S Syndrome ◽  
Factor Ii ◽  
Sheehan's Syndrome ◽  
Pai 1

Sheehan’s Syndrome (SS) is defined as pituitary hormone deficiency due to ischemic infarction of the pituitary gland as a result of massive postpartum uterine hemorrhage. Herein, we aimed to investigate the roles ofFactor II(G20210A),Factor V(G1691A),MTHFR(C677T and A1298C),PAI-14G/5G, andTNF-α(-308  G>A) gene polymorphisms in the etiopathogenesis of SS. Venous blood samples were obtained from 53 cases with SS and 43 healthy women. Standard methods were used to extract the genomic DNAs.Factor II(G20210A),Factor V(G1691A), andMTHFR(C677T and A1298C) polymorphisms were identified by real-time PCR.PAI-14G/5G andTNF-α(-308  G>A) gene polymorphisms were detected with polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) methods. According to statistical analysis, none of the polymorphisms were found to be significantly higher in the SS group compared to the control group. Hence, we suggest that genetic factors other thanFactor II, Factor V, MTHFR, PAI-1, andTNF-αgene polymorphisms should be researched in the etiopathogenesis of SS.

scholarly journals Great Obstetrical Syndromes In G20210a Mutation Carriers Associated With High Prothrombin Activity

2020 ◽  
Author(s):  
Mariya Nikolaeva ◽  
Andrey Pavlovich Momot ◽  
Marina Sabirovna Zainulina ◽  
Natalia Nikolaevna Yasafova ◽  
Irina Alekseevna Taranenko
Keyword(s):  
Blood Plasma ◽  
Venous Blood ◽  
Threshold Value ◽  
Main Group ◽  
Trophoblast Invasion ◽  
Control Group ◽  
G20210a Mutation ◽  
Factor Ii ◽  
Invasion Waves ◽  
In Blood Plasma

Abstract Objective: to study the association between high activity of Factor II (prothrombin) in blood plasma with G20210A mutation and the development of great obstetrical syndromes.Material and methods: A prospective clinical cohort study was conducted on 290 pregnant women (average age 31.7±4.7 years old). The main group was made up of 140 G20210A patients, while the control group comprised 150 women with the wild G20210G type. The aim was to evaluate the activity of Factor II in the venous blood plasma during the stages of pregnancy with regard to trophoblast invasion waves. As per results, association analysis of Factor II activity value and gestational complications was carried out.Results: In the control group, the median (Me) of Factor II activity ranged from 108% (preconception period) to 144% (pregnancy) [95% CI 130-150]. In patients with the GA type, the value was significantly higher in related periods, ranging from 149% to 181% [95% CI 142-195], p<0.0001. With Factor II activity ranging from 148.5% to 180.6%, pregnancies in the main group had no complications. Higher levels of Factor II activity were associated with the development of early and/or severe preeclampsia (PE) and fetal growth retardation (FGR).Conclusion: The data obtained regarding Factor II activity in blood plasma, juxtaposed with the development of great obstetrical syndromes, allow to assume that manifestation of G20210A in early and/or severe PE and FGR is associated with this coagulation factor's level of activity. Threshold value of the Factor II activity with G20210A mutation, allowing to predict the development of PE, comprised 171.0% at the preconception stage (AUC – 0.86; p<0.0001) and within 7-8 weeks of gestation it was 181.3% (AUC – 0.84; p<0.0001).

Prevalence of the Factor V G1691A and the Factor II/prothrombin G20210A gene polymorphisms among Tamilians

2005 ◽  
Vol 79 (1) ◽  
pp. 9-13 ◽  
Author(s):  
T. Angeline ◽  
Heather A. Bentley ◽  
Arnold B. Hawk ◽  
Richard J. Manners ◽  
Harsha A. Mokashi ◽  
...  
Keyword(s):  
Gene Polymorphisms ◽  
Prothrombin G20210a ◽  
Factor V ◽  
Factor Ii ◽  
Factor V G1691a

scholarly journals MON-243 Atypical Presentation of Isolated Adrenocorticotropic Hormone Deficiency and Sheehan’s Syndrome

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Zahira Marie Lugo López ◽  
Nadyeschka Angelique Rivera Santana ◽  
Andrea del Toro Diez ◽  
Michelle Marie Mangual Garcia ◽  
Ernesto Sola Sanchez ◽  
...  
Keyword(s):  
Postpartum Hemorrhage ◽  
Adrenocorticotropic Hormone ◽  
Brain Mri ◽  
Pituitary Hormones ◽  
Hormone Deficiency ◽  
Normal Brain ◽  
Sheehan’S Syndrome ◽  
Isolated Acth Deficiency ◽  
Acth Deficiency ◽  
Sheehan's Syndrome

Abstract Introduction: Isolated adrenocorticotropic hormone (ACTH) deficiency is a rare pituitary hormone deficiency defined by secondary adrenal insufficiency and normal secretion of all other pituitary hormones. Patients present with fatigue, weakness, weight loss, anorexia, nausea, low cortisol levels and low ACTH levels. Isolated ACTH deficiency is more common in males and usually presents in the fifth decade of life. Main mechanisms involved in the pathogenesis are genetics and autoimmune causes, traumatic brain injury and infarction of the pituitary postpartum, known as Sheehan’s syndrome. Sheehan’s syndrome is characterized by postpartum hemorrhage, failure to lactate and menstrual irregularities and it can occur from immediate postpartum period to years after delivery. The most common hormone deficiencies are prolactin and growth hormone. Empty sella is the most common finding on brain MRI. We are reporting a case of a woman in her third decade with isolated ACTH deficiency due to Sheehan’s syndrome two years postpartum, able to lactate, with normal menses and normal brain MRI. Clinical Case: A 33-year-old woman G3P3A0 with hypothyroidism who was referred to Endocrinology clinics due to tiredness, fatigue and weakness. She reported postpartum hemorrhage requiring 4 PRBC transfusions and IV steroids after last pregnancy 5 years ago. Patient was able to lactate after pregnancy and continued in her usual state of health until 3 years ago when she referred loss of consciousness with traumatic head injury due to hypoglycemia. At Endocrinology office physical examination and vital signs were unremarkable, including no blood pressure or heart rate variations with positional changes. Despite hypothyroidism being adequately controlled, she continued with extreme fatigue and weakness affecting her quality of life, for which cortisol and ACTH levels were ordered. Laboratories showed normal electrolytes, negative autoantibodies, cortisol 0.20 μg/dL (5-25 μg/dL) and ACTH 22 pg/mL (10-60 pg/mL) suggesting partial isolated ACTH deficiency. ACTH stimulation test was done and noted with suboptimal response. Evaluation of other anterior pituitary hormones was normal. Brain MRI showed normal pituitary gland. She was started on hydrocortisone in AM and PM and symptoms resolved. Conclusion: Immediate recognition of isolated ACTH deficiency due to Sheehan’s syndrome is necessary due to the availability of effective treatment and morbidity and mortality associated with this serious condition. To our knowledge isolated ACTH deficiency due to Sheehan’s syndrome in which the patient was able to lactate and normal findings on brain MRI has not previously been reported.References: Shivaprasad C. Sheehan’s Syndrome: Newer advances. Indian J Endocrinol Metab. 2011 Sep; 15(3): S203-207. DOI:10.4103/2230-8210.84869.

Blood markers of fibrinolysis system and vascular wall state in neonates born to mothers with preeclampsia

2021 ◽  
Author(s):  
И.Г. Попова ◽  
С.Б. Назаров ◽  
О.Г. Ситникова ◽  
Г.Н. Кузьменко ◽  
М.М. Клычева ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Venous Blood ◽  
Vascular Wall ◽  
Endothelial Damage ◽  
Control Group ◽  
Blood Levels ◽  
Hemorrhagic Complications ◽  
Tissue Plasminogen ◽  
Pai 1

Введение. Новорожденные, родившиеся у матерей с патологией во время беременности, составляют группу высокого риска тромботических и геморрагических осложнений, которые повышаются при наличии у новорожденных перинатальной патологии. Цель исследования: оценить показатели, характеризующие состояние системы фибринолиза и сосудистой стенки в крови новорожденных, родившихся у матерей с преэклампсией (ПЭ), для прогнозирования риска тромботических и геморрагических осложнений у таких детей. Материалы и методы. Обследовано 60 новорожденных, родившихся у матерей с ПЭ. Контрольную группу составили 30 новорожденных от матерей без ПЭ. Исследовали венозную кровь, взятую у новорожденных на 3–5-е сутки жизни. В крови определяли уровень тканевого активатора плазминогена (t-РА), ингибитора тканевого активатора плазминогена (PAI-1) и тромбомодулина. Результаты. Выявлено, что у новорожденных от матерей с ПЭ на 3–5-е сутки жизни отмечаются признаки повреждения эндотелия и повышение фибринолитической активности крови, на что указывает повышение содержания t-РА, PAI-1 и тромбомодулина в крови. Заключение. Полученные данные свидетельствуют о риске развития геморрагических осложнений у таких детей. Background. Neonates born to mothers with pathology during pregnancy are at high risk of thrombotic and hemorrhagic complications that are increased if neonates have perinatal pathology. Objectives: to assess blood parameters characterizing fibrinolysis and vascular wall of neonates born to mothers with preeclampsia (РЕ), to predict the risk of hemorrhagic complications in these children. Patients/Methods. 60 neonates born to mothers with РЕ were examined. The control group consisted of 30 neonates born to mothers without РЕ. We studied levels of tissue plasminogen activator (t-PA), inhibitor of tissue plasminogen activator (PAI-1) and thrombomodulin (TM) in venous blood taken from neonates on the 3–5th days of life. Results. In neonates born to mothers with PE we revealed on the 3–5th days of life increased blood levels of t-PA, PAI-1 and TM that characterized endothelial damage and increased blood fibrinolytic activity. Conclusions. The data obtained indicate the risk of hemorrhagic complications development in these children.

scholarly journals Pregnancy complications in G20210A mutation carriers associated with high prothrombin activity

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
M. G. Nikolaeva ◽  
A. P. Momot ◽  
M. S. Zainulina ◽  
N. N. Yasafova ◽  
I. A. Taranenko
Keyword(s):  
Blood Plasma ◽  
Venous Blood ◽  
Threshold Value ◽  
Main Group ◽  
Trophoblast Invasion ◽  
Control Group ◽  
G20210a Mutation ◽  
Factor Ii ◽  
Invasion Waves ◽  
In Blood Plasma

Abstract Objective To study the association between high activity of Factor II (prothrombin) in blood plasma with G20210A mutation and the development of great obstetrical syndromes. Material and methods A prospective clinical cohort study was conducted on 290 pregnant women (average age 31.7 ± 4.7 years old). The main group was made up of 140 G20210A patients, while the control group comprised 150 women with the wild G20210G type. The aim was to evaluate the activity of Factor II in the venous blood plasma during the stages of pregnancy with regard to trophoblast invasion waves. As per results, association analysis of Factor II activity value and gestational complications was carried out. Results In the control group, the median (Me) of Factor II activity ranged from 108% (preconception period) to 144% (pregnancy) [95% CI 130–150]. In patients with the GA type, the value was significantly higher in related periods, ranging from 149 to 181% [95% CI 142–195], p < 0.0001. With Factor II activity ranging from 148.5 to 180.6%, pregnancies in the main group had no complications. Higher levels of Factor II activity were associated with the development of early and/or severe preeclampsia (PE) and fetal growth retardation (FGR). Conclusion The data obtained regarding Factor II activity in blood plasma, juxtaposed with the development of great obstetrical syndromes, allow to assume that manifestation of G20210A in early and/or severe PE and FGR is associated with this coagulation factor’s level of activity. Threshold value of the Factor II activity with G20210A mutation, allowing to predict the development of PE, comprised 171.0% at the preconception stage (AUC – 0.86; p < 0.0001) and within 7–8 weeks of gestation it was 181.3% (AUC – 0.84; p < 0.0001).

scholarly journals Sheehan’s syndrome: baseline characteristics and effect of 2 years of growth hormone replacement therapy in 91 patients in KIMS – Pfizer International Metabolic Database

2005 ◽  
Vol 152 (4) ◽  
pp. 581-587 ◽  
Author(s):  
Fahrettin Keleştimur ◽  
Peter Jonsson ◽  
Senay Molvalilar ◽  
Jose Manuel Gomez ◽  
Christoph J Auernhammer ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Replacement Therapy ◽  
Hormone Replacement ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Hormone Deficiency ◽  
Sheehan’S Syndrome ◽  
Gh Replacement ◽  
Sheehan's Syndrome ◽  
Baseline Characteristics

Objective: Sheehan’s syndrome occurs as a result of ischaemic pituitary necrosis due to severe postpartum haemorrhage. It is one of the most important causes of hypopituitarism, and hence growth hormone deficiency (GHD), in developing countries. However, little is known about the effects of growth hormone (GH) replacement therapy in patients with Sheehan’s syndrome. Design: The demographic background characteristics of 91 GH-deficient patients with Sheehan’s syndrome (mean age ± s.d., 46.3 ± 9.4 years) were compared with those of a group of 156 GH-deficient women (mean age ± s.d., 51.5 ± 13.1 years) with a non-functional pituitary adenoma (NFPA). The baseline characteristics and the effects of 2 years of GH replacement therapy were also studied in the 91 patients with Sheehan’s syndrome and an age-matched group of 100 women with NFPA (mean age ± s.d. 44.5 ± 10.2 years). Results: All patients were enrolled in KIMS (Pfizer International Metabolic Database). Patients with Sheehan’s syndrome were significantly younger at pituitary disorder onset, diagnosis of GHD and at entry into KIMS than patients with NFPA (P < 0.01), and had significantly lower insulin-like growth factor I levels (P < 0.001). At baseline, quality of life (QoL) was significantly (P < 0.05) reduced in patients with Sheehan’s syndrome compared with those with NFPA (P < 0.001). With regard to treatment effects, lean body mass increased significantly (P < 0.05), QoL improved significantly (P < 0.05) and total and low-density lipoprotein-cholesterol decreased significantly (P < 0.05) in patients with Sheehan’s syndrome after 1 year of GH replacement therapy. Similar significant changes in QoL and lipid profiles occurred in patients with NFPA after 2 years of GH replacement. Blood pressure remained unchanged in patients with Sheehan’s syndrome, but decreased significantly (P < 0.01) in the group with NFPA after 1 year, before returning to pretreatment levels at 2 years. Conclusions: In conclusion, patients with Sheehan’s syndrome have more severe GHD compared with individuals with NFPA. GH replacement therapy in patients with Sheehan’s syndrome may have beneficial effects on QoL, body composition and lipid profile.

scholarly journals Acute Sheehan’s syndrome manifesting initially with diabetes insipidus postpartum: a case report and systematic literature review

2021 ◽  
Author(s):  
Gregor Leonhard Olmes ◽  
Erich-Franz Solomayer ◽  
Julia Caroline Radosa ◽  
Panagiotis Sklavounos ◽  
Philipp Agne ◽  
...  
Keyword(s):  
Systematic Review ◽  
Literature Review ◽  
Diabetes Insipidus ◽  
Case Reports ◽  
Hormone Replacement ◽  
Disease Onset ◽  
Brain Magnetic Resonance Imaging ◽  
Pituitary Hormone ◽  
Sheehan’S Syndrome ◽  
Sheehan's Syndrome

Abstract Purpose Acute Sheehan’s syndrome is a rare, but potentially life-threatening, obstetric event that can be complicated by diabetes insipidus. Little information on the diagnosis and treatment of Sheehan’s syndrome with diabetes insipidus is available. We report on a 28-year-old patient who developed acute Sheehan’s syndrome with diabetes insipidus after giving birth, and on a systematic review of similar cases. Methods We performed a systematic review of the literature cataloged in PubMed and Google Scholar using the keywords “Sheehan syndrome” OR “Sheehan's syndrome” AND “diabetes insipidus” to identify relevant case reports published between 1990 and 2021. Eight Reports met the inclusion criteria (English-language abstracts available, onset in the puerperium, information about the day of the onset). Results In the present case, postpartum curettage was necessary to remove the residual placenta. The total amount of blood loss was severe (2500 ml). On the second day postpartal, the patient developed polyuria. Laboratory analysis revealed hypernatremia with increased serum osmolality and decreased urinary osmolality. Hormone analysis showed partial hypopituitarism involving the thyroid, corticotropic, and gonadotropic axes. The prolactin level was elevated. Brain magnetic resonance imaging showed pituitary gland infarction. Desmopressin therapy was initiated and resolved the polyuria. Hormone replacement therapy was administered. Four months later, the patient was well, with partial diabetes insipidus. The literature review indicated that this case was typical in terms of symptoms and disease onset. Most reported cases involve hypotension and peripartum hemorrhage, but some patients without hemorrhage also develop Sheehan’s syndrome. Elevated prolactin levels are uncommon and associated with poor prognosis in patients with Sheehan’s syndrome. Conclusion Acute Sheehan’s syndrome with diabetes insipidus involves nearly all pituitary hormone axes, indicating severe disease. Prolactin elevation could suggest that a case of Sheehan’s syndrome is severe.

scholarly journals Gestational complications of the prothrombin G20210A mutation related to prothrombin activity

2020 ◽  
Vol 14 (2) ◽  
pp. 192-202
Author(s):  
M. G. Nikolaeva ◽  
N. N. Yasafova ◽  
A. P. Momot ◽  
M. S. Zainulina ◽  
K. A. Momot ◽  
...  
Keyword(s):  
Blood Plasma ◽  
Venous Blood ◽  
Threshold Value ◽  
Prothrombin G20210a ◽  
Control Group ◽  
Study Group ◽  
Fetal Growth Retardation ◽  
Prothrombin Activity ◽  
G20210a Mutation ◽  
Factor Ii

Aim: to study the association between prothrombin activity in the blood plasma and gestational complications in women with the prothrombin G20210A mutation.Materials and methods. A prospective clinical cohort study including 290 pregnant women aged 18 to 45 years was conducted from 2012 to 2018. Two cohorts were formed: a study group of 140 patients with the GA genotype and a control group of 150 women with the GG genotype. In the groups, the activity of prothrombin (Factor II) in the venous blood plasma was evaluated during pregnancy. The stages of cytotrophoblast invasion were taken into account when relating the prothrombin activity to gestational complications.Results. The median prothrombin activity in the control group ranged from 108 % during the preconception period to 144 % during pregnancy (95 % CI = 130–150). In the study group with the GA genotype, the activity was significantly higher at the same periods: from 149 to 181 % (95 % CI = 142–195; p < 0.0001). With the prothrombin activity from 148.5 to 180.6 %, the pregnancy in the study group progressed normally. Higher levels of prothrombin activity were associated with early and/or severe preeclampsia (PE), and fetal growth retardation (FGR).Conclusion. The obtained data on prothrombin activity in the blood plasma during pregnancy complications suggest that the manifestation of the GA genotype in the form of early and/or severe PE and FGR is associated with the level of plasma prothrombin activity. The threshold value of Factor II activity was calculated for patients with the G20210A mutation; based on this value it becomes possible to predict PE at the preconception stage (171.0 %; AUC – 0.86; p < 0.0001) and at a gestational age of 7–8 weeks (181.3 %; AUC – 0.84; p < 0.0001).

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