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Hypopituitarism resulting from an infarct of the pituitary gland. Damage to the anterior portion of the pituitary gland causes partial or complete loss of thyroid, adrenocorticoid, and gonadal functions. Pituitary infarction can very rarely occur with diabetic vasculitis, sickle cell anemia, and idiopathic disease. Postpartum hemorrhage and cardiovascular shock is better known as Sheehan syndrome whereas this pituitary condition is better known as Simmonds syndrome.

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Glinski-Simmonds Syndrome; Simmonds Cachexia; Hypopituitarism Syndrome; Panhypopituitarism Syndrome; Pituitary Cachexia.

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In 1939, the German Medical Society recommended that anterior pituitary deficiency be called Simmonds Disease, named after Maurice Simmonds, German physician, who, in 1914, described a female patient with chronic pituitary failure following puerperal sepsis. Nowadays, postpartum hypopituitarism is better known as Sheehan syndrome whereas all other pituitary failure are known as Simmonds Disease.

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Can occur in both sexes but more prevalent in females. The onset usually occurs in the postpubertal period.

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Hypofunction and atrophy of the anterior pituitary gland can be observed with tumors, infections, surgery, or radiotherapy; occasionally idiopathic; associated with secondary atrophy of the thyroid gland, adrenal glands, and the gonads.

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Asthenia and weight loss, atrophy of all body tissues; loss of body hair, atrophic skin; genital organ atrophy, loss of libido and potency; hypothermia sensitive; bradycardia and severe postural hypotension; psychic changes are all characteristic of this medical condition.

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History and clinical features; biochemical (low levels of T3, T4, thyroid-stimulating hormone, adrenocorticotropic hormone (ACTH), and gonadotropins); anemia; low basal metabolic rate; radiology (pituitary tumor demonstrated by CT scan of brain).

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Preoperative replacement therapy should be undertaken because dramatic improvement can be expected; in the untreated case, the patient will be bradycardic and hemodynamically unstable perioperatively. Slow clearance of drugs renders the patient sensitive to effects of most drugs, including anesthetic drugs, opioids, and neuromuscular blockers; prone to hypothermia intraoperatively.

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Careful titration of doses of intravenous anesthetic drugs, including barbiturate and opioids, must be done to avoid hypotension. Adequate hydrocortisone cover before, during, and after anesthesia is essential.

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Sheehan Syndrome: Hypopituitarism resulting from an infarct of the pituitary gland following postpartum shock or hemorrhage. Damage to the anterior portion of the pituitary gland causes partial or complete loss of thyroid, adrenocorticoid, and gonadal functions.

Birch CA: Simmonds disease. Morris Simmonds 1855-1925. Practitioner 212(1271):737, 1974.
Magalini IM, Magalini SC: Simmonds, in Dictionary of Medical Syndromes. 3rd ed. New York, Lippincott, 1990, p 816.

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