A case report of extra pontine myelinolysis secondary to severe hyponatremia due to pituitary crisis in a patient with Sheehan′s syndrome
10.3760/cma.j.cn311282-20240510-00192
- VernacularTitle:希恩综合征合并低钠血症昏迷型垂体危象继发脑桥外髓鞘溶解症一例病例报道
- Author:
Xiaoyun LIU
1
;
Yao QIN
;
Jingyu GU
;
Lanyun YAN
;
Jie GONG
;
Shanshan LU
;
Mei ZHANG
Author Information
1. 南京医科大学第一附属医院内分泌科，南京 210029
- Publication Type:Journal Article
- Keywords:
Sheehan′s syndrome;
Pituitary crisis;
Hyponatremia;
Extrapontine myelinolysis syndrome;
Coronavirus disease 2019
- From:
Chinese Journal of Endocrinology and Metabolism
2024;40(12):1068-1073
- CountryChina
- Language:Chinese
-
Abstract:
Sheehan syndrome requires life-long hormone replacement therapy, and discontinuation of medication can lead to a pituitary crisis. We report a case of a patient with Sheehan syndrome who developed loss of consciousness and severe hyponatremia after abruptly discontinuing medication due to coronavirus disease 2019(COVID-19) infection. After resuscitation, the patient gradually regained consciousness but developed slurred speech, unresponsiveness, and muscle weakness five days later. Brain magnetic resonance imaging(MRI) revealed extrapontine myelinolysis. Treatment with gamma globulin and glucocorticoids led to gradual recovery of consciousness, speech function, and muscle strength. The patient regained independent living abilities after six months of rehabilitation. This case underscores the necessity of continuous hormone therapy and highlights the potential risks of abrupt medication cessation in Sheehan syndrome. Additionally, in patients with severe hyponatremia and pituitary crisis, attention should be paid to the speed of serum sodium recovery. Timely recognition and management of neurological complications, such as myelinolysis, are essential for improving outcomes.
