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.
Glinski-Simmonds Syndrome; Simmonds Cachexia;
Hypopituitarism Syndrome; Panhypopituitarism Syndrome; Pituitary Cachexia.
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.
Can occur in both sexes but more prevalent in females.
The onset usually occurs in the postpubertal period.
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.
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.
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).
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.
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.
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,
Magalini IM, Magalini SC: Simmonds, in Dictionary of Medical Syndromes. 3rd ed. New York, Lippincott, 1990,