Evaluation of the periodontal status of a patient diagnosed with Sheehan syndrome: A case report

Aim: Some immunological changes occurring in mothers during pregnancy increase their susceptibility to infections, including periodontal infections. Sheehan syndrome (SS) is a disease that occurs because of severe postpartum hemorrhage causing ischemic pituitary necrosis. The presence of multiple hormonal deficiencies leads to the impairment of bone microarchitecture, which can cause osteopenia and even osteoporosis. Osteoporosis and periodontitis are both chronic diseases characterized by bone loss. Moreover, recent studies have shown that there is a relationship between menopause, osteoporosis, alveolar bone resorption, and tooth loss. This case report aims to evaluate the oral and periodontal status of a patient with SS and to raise awareness about dental and periodontal problems that may occur in such patients. Methodology: A 63-year-old female patient diagnosed with SS in the endocrinology clinic was referred to the periodontology clinic with complaints of multiple tooth loss, mobility in her teeth, and gingival bleeding. In the clinical and radiographic examination of the patient, it was determined that all teeth had horizontal bone resorption; moreover, there was mobility in the mandibular anterior teeth and hemorrhage in the gums. When the patient’s laboratory results were examined, it was seen that the basal plasma levels of free triiodothyronine (T3) and thyroxine (T4), growth hormone (GH), prolactin (PRL), follicle stimulating hormone (FSH), luteinizing hormone (LH), progesterone, and total testosterone values were significantly lower, and the anterior pituitary elevation was significantly decreased in pituitary magnetic resonance (MR) imaging. Conclusion: The periodontium is the target tissue of sex and other hormones. Hormonal changes may affect the inflammatory–immune tissue responses of periodontal tissues. Many studies have shown that thyroid and sex hormones affect oral and especially periodontal tissues. The degradation of hormonal hemostasis may induce a series of pathological events in the oral environment, resulting in inflammatory changes in gingival tissues, periodontal attachment losses, and destruction of the alveolar bone. Systemic diseases that affect hormonal conditions, such as SS, must be considered in the evaluation of oral health. Medical physicians should refer their patients to the dentist for consultation when evaluating patients’ hormonal status and planning their treatment. How to cite this article: Şen SC, Saygun NI, Or Koca A, Özcan E. Evaluation of the periodontal status of a patient diagnosed with Sheehan syndrome: A case report. Int Dent Res 2021;11(Suppl.1):308-11. https://doi.org/10.5577/intdentres.2021.vol11.suppl1.46 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Co-presentation of Acute Sheehan Syndrome with Raised Intracranial Pressure in a Post-partum Lady

Sheehan’s syndrome (SS) or necrosis of pituitary gland is a rare complication of severe postpartum hemorrhage. It may cause hypopituitarism immediately or several years later, depending on the degree of tissue destruction. Sheehan’s syndrome though rare is still one of the commonest causes of hypopituitarism in developing countries like ours. The presence of an intercurrent infection and administration of thyroxine exacerbated her corticosteroid insufficiency. Intracranial hypertension (IH) manifested as bilateral optic disc swelling with reduced visual acuity, bilateral sixth nerve palsies, and impaired consciousness. Intracranial hypertension (IH) has been associated with hypocortisolism caused by either primary adrenocortical insufficiency or corticosteroid withdrawal. The author describes a case of a young lady with IH with acute SS who presented on 3rd day postpartum after lower uterine cesarean section with acute severe symptomatic hyponatremia which was complicated by postpartum hemorrhage. The clinical manifestations of IH resolved with corticosteroid replacement

Cephalometric predictors of abnormal sella turcica among individuals with Sheehan Syndrome: A case-control study

The present study aimed to analyze cephalometric predictors of abnormal sella turcica (ST) in Sheehan Syndrome (SS) patients. An observational case-control study was performed with SS volunteers from the Endocrinology and Diabetology Service of the Walter Cantídio University Hospital (Brazil). The sample was composed of 32 patients allocated in two groups: case group (16 adult women diagnosed with SS) and control group (16 healthy individuals matched by sex and age). Analyzes of the linear dimensions (length, diameter, and depth) of the ST on lateral teleradiographies were made using the Radiocef Studio 2 software. The morphological pattern (anterior oblique wall, double floor contour, bridged, irregularities of the dorsal face, pyramidal) was also assessed. The subjects mean age was 65.47 ± 10.19 years. SS patients had lower mean length (p <0.001), width (p <0.001) and height (p = 0.033) compared to the control group. The presence of morphological alteration of the ST was statistically significant (p = 0.009) compared to the controls. The most frequent morphological changes were irregularities of the dorsal face (37.5%; p = 0.018), oblique anterior wall (12.5%), double floor contour (6.3%), and bridged appearance (6.3%). Our study found smaller dimensions and morphological variations of ST in Brazilian SS individuals, highlighting the importance of ST-related imaging screening.

Sheehan Syndrome Presenting with Psychotic Manifestations Mimicking Schizophrenia in a Young Female: A Case Report and Review of the Literature

Introduction. Sheehan syndrome presents with features of multiple hormone deficiencies including lactation failure and amenorrhoea as well as with features of central hypothyroidism and adrenocorticotropic hormone deficiency. Psychiatric manifestations are mostly limited to cognitive impairment. Psychotic presentations are rare and limited to case reports. Case Presentation. A 32-year-old female was evaluated for fearfulness and delusions for one year. She had persecutory and bizarre delusions, delusion of thought possession, and elementary auditory hallucinations. These began four months after the birth of her third child. The delivery had been complicated with postpartum haemorrhage. Her symptoms caused the functional decline and progressively worsened, resulting in suicidal ideation. Cognitive assessment revealed mild impairment in attention. Further inquiry revealed lethargy, constipation, cold intolerance, and lactation failure. She was slow, having dry skin, puffy face, and bradycardia with a blood pressure of 80/60 mmHg (supine) and 70/50 mmHg (standing). She had hyponatraemia, elevated creatine phosphokinase, low thyroxine, prolactin, FSH, LH, and IGF-1. She had poor cortisol and growth hormone response to the insulin tolerance test. MRI-pituitary showed empty sella. A diagnosis of Sheehan syndrome was made. Her symptoms improved completely after the initiation of levothyroxine and hydrocortisone. Conclusions. Sheehan syndrome can present with psychotic symptoms mimicking schizophrenia with variable involvement of cognition. Detailed reporting of these patients would enhance better characterization of the clinical presentation and risk profile of these patients.