User talk:Cjs22/sandbox2

Hi Chris! So I like everything that you've added: especially the "Cessation of menses..." (Signs and Symptoms) and "Necrosis may occur..." (Causes) statements, because those narrative bridges were definitely needed. Also, I think you should try to explain that "The potassium level..." situation in the end of Signs and Symptoms as well. That sentence just feels kinda random.

When peer reviewing, I'm best at helping with syntax and grammar/punctuation; I'll definitely do some researching to find at least one article that might be useful for the Pathophysiology or Treatment sections, but that'll be a little later in the week. For now, I've got your back on making it sound really good. All of my changes will be in all caps, because wikipedia doesn't believe in different color fonts.

So, Signs and Symptoms:

The various signs and symptoms in Sheehan's syndrome are caused by damage to the pituitary, thereby causing a decrease in one or more OF THE hormones it normally secretes. BECAUSE the pituitary controls many glands in the endocrine system, partial or complete loss of a variety of functions may result.

Most common initial symptoms of Sheehan's syndrome are agalactorrhea (absence of lactation) and/or difficulties with lactation.[2] Many women also report amenorrhea or oligomenorrhea after delivery.[2] In some cases, a woman with Sheehan syndrome might be relatively asymptomatic, SO the diagnosis WOULD not BE made until years later, with features of hypopituitarism.[2] Such features include secondary hypothyroidism with tiredness, intolerance to cold, constipation, weight gain, hair loss and slowed thinking, as well as a slowed heart rate and low blood pressure. Another such feature is secondary adrenal insufficiency, which, in the MORE chronic case, is similar to Addison's disease with symptoms including fatigue, weight loss, hypoglycemia (low blood sugar levels), anemia and hyponatremia (low sodium levels). Such a PATIENT may, however, become acutely exacerbated when her body is stressed by, for example, a severe infection or surgery years after her delivery, a condition equivalent with an Addisonian crisis.[2] The symptoms of adrenal crisis should be treated immediately and can be life-threatening.[3] Gonadotropin deficiency will often cause amenorrhea, oligomenorrhea, hot flashes, or decreased libido.[2] Cessation of menses is an important indicator of Gonadotropin deficiency as a result of Sheehan’s syndrome[4]. Growth hormone deficiency causes many vague symptoms including fatigue and decreased muscle mass.[2]

Growth hormone deficiency is the most common symptom of hypopituitarism seen in Sheehan’s syndrome with a 90%-100% occurrence seen in the Netherlands, Costa Rica, and Saudi Arabia. In these populations the occurrence of Cortisol, TSH, and gonadotropin deficiencies ranges from 50 to 100%.[5]

Uncommonly, Sheehan syndrome may also appear acutely after delivery, mainly by hyponatremia.[2] There are several possible mechanisms by which hypopituitarism can result in hyponatremia, including decreased free-water clearance by hypothyroidism, direct syndrome of inappropriate antidiuretic hormone (ADH) hypersecretion, decreased free-water clearance by glucocorticoid deficiency (independent of ADH).[2] The potassium level in these situations is normal, because adrenal production of aldosterone is not dependent on the pituitary.[2]

Causes

In the developed world, SHEEHAN'S is a rare complication of pregnancy, usually MANIFESTING after excessive blood loss after delivery. The presence of disseminated intravascular coagulation (i.e., in amniotic fluid embolism or HELLP syndrome) also appears to be a factor in its development. A retrospective study in {CAPITALIZED THIS -->} Turkey found that the prevalence of Sheehan’s syndrome was directly proportional TO the amount of at-home deliveries each decade [5]. {ADDED A PERIOD}

Pituitary necrosis may directly result from a lack of blood flow in the hypophyseal artery as a result of pituitary gland enlargement during pregnancy.[6]Ischemia may occur as a result of vasospasm, thrombosis, or vascular compression sometimes as a result of an increase in the amount of lactotroph cells throughout gestation (contributing to the enlargement of the pituitary gland).[7] Necrosis may occur as a result of severe hypotension or shock due to excessive uterine bleeding following childbirth.[7]. Sheehan’s syndrome may occur as a result of the arterial constriction and abnormal hypotension in conjunction with an insufficiency to meet the increased demand in blood supply of the pituitary gland seen during pregnancy.[7]

Some possible predisposing factors to Sheehan’s syndrome may include: inherited or acquired disseminated blood coagulation (DIC), {ADDED COMMA} restriction OF pituitary blood supply, small sella size, vasospasm, or thrombosis.[7] Post-Partum Hemorrhaging (PPH) is believed to be a predictor of Sheehan’s syndrome, so THE SYMPTOMS OF {DELETED ALL OF THE TEXT BETWEEN SO AND ANEMIA} anaemia, obesity, and advanced maternal age may increase the risk of Sheehan's Syndrome.[7]

Pathophysiology

Sheehan's syndrome is caused by damage to the pituitary, thereby causing a decrease in one or more OF THE hormones it normally secretes. {DELETED SECONDLY} The anterior pituitary is supplied by a low pressure portal venous system.[medical citation needed] A 1995 study found that 56.2% of patients with diagnosed Sheehan’s syndrome experienced a loss of all pituitary hormones, with the remaining 43.8% having selective pituitary insufficiency. However, {DELETED LIKELY} because the growth hormone-secreting cells are located at the periphery of the pituitary, and are therefore most likely to be affected by ischemia, all OF the patients EXPERIENCED growth hormone deficiency.[8]

Diagnosis {IT'S PRETTY OBVIOUS THAT YOU HAVE TO ADD TO THIS AND ALL FOLLOWING SECTIONS LOL}

Hormonal assays: there may be low LEVELS of T4, TSH, estrogen {WHICH ESTROGEN}, gonadotropin, cortisol, and ACTH depending on the extent of necrosis. {ADDED AN OXFORD COMMA AND A PERIOD}

MRI of the pituitary and hypothalamus: this helps to exclude tumor or other pathologies. {LITERALLY WHO WROTE THIS SECTION}

Treatment

Lifelong hormone replacement therapy for the hormones that are missing. [9]

Epidemiology

In a study of 1,034 symptomatic adults, Sheehan'S syndrome was found to be the sixth most frequent etiology of growth hormone deficiency, being responsible for 3.1% of cases (versus 53.9% due to a pituitary tumor).[10]

Sheehan'S syndrome is more prevalent in developing countries than developed countries.[11] Additionally, it was found that the majority of women who experienced Sheehan syndrome gave birth at home RATHER THAN IN A HOSPITAL. {DID THIS SOURCE SAY ANYTHING ABOUT WHETHER THEY GAVE BIRTH WITH A MIDWIFE PRESENT OR HAD A HOME BIRTH WITHOUT ANY PROFESSIONAL ASSISTANCE?}

History

The specific association with postpartum shock or haemorrhage was described in 1937 by the British pathologist Harold Leeming Sheehan (1900–1988),[12] whereas Simmonds' disease occurs in either sex due to causes unrelated to pregnancy. {WHY IS THIS RELEVANT? IS IT RELEVANT?}

According to Sheehan, {ADDED COMMA} in 1939, approximately 41% of survivors of severe postpartum hemorrhage (PPH) and/or hypovolemic shock experienced severe or partial hypopituitarism.[7]

Alabrutto (talk) 04:11, 25 March 2019 (UTC)

Peer Review Response

Hi Anne Marie,

Thanks for your review. I implemented all of the grammatical changes that you've shown me in your review. I'll elaborate more about what the previous author had said regarding the "potassium level". Also, someone had left in some information about Simmonds disease. I believe this was relevant to the classification of Sheehan's syndrome. So, I'll leave it in the history section, but I'm going to do some more research to try and tie it together in a more meaningful way.

I've already started to add more information regarding the diagnostic process. I think the previous authors had left it more general because Sheehan's syndrome itself is pretty general. However, I found some more information in some reviews that are more specific to the diagnostics of Sheehan's syndrome and other ailments that involve hypopituitarism.

Cjs22 (talk) 20:47, 12 April 2019 (UTC)Cjs22