Differences between apoplexy and Sheehan.
I told you that the-the pathogenesis that
it shares with would be more or less with
massive haemorrhage into the adrenals.
That’s Waterhouse–Friderichsen, completely
But, this is acute haemorrhage into the pituitary
tumour resulting in what?
There will be sudden headache because now,
literally, sella’s filling up with blood
so very quickly.
It’s going to be a sudden headache and the
fact that the optic chiasm is been affected
or compromised resulting in bitemporal hemianopsia.
It might also have issues with cranial nerves
III oculomotor, trochlear 4 and then maybe
something like your 6 abducens, meaning to
say you’re going to have visual issues.
With this sudden rush of blood into your sella,
this is not about you going in there and removing
This is about you relieving that pressure
Once again, when this is taking place, what’s
the most important hormone that you’re always
paying attention to?
It’s the cortisol, cortisol, cortisol.
In addition, understand that the pituitary…
Do not, I mean, when there’s talk about
insufficiency, do not just restrict yourself
to the anterior pituitary.
Your patient might not have ADH, may result
in symptoms of what?
Central diabetes insipidus.
Are we clear?
Are we clear?
Most dangerous of them all would be your secondary
adrenal insufficiency due to lack of ACTH.
So, what’s your treatment?
Please make sure that you treat your patient,
manage, manage, manage.
Glucocorticoid, glucocorticoid, glucocorticoid.
I cannot stress that enough.
There will be certain interesting topics that
we’ll walk through there.
When we start talking about the most common
cause of Cushing in the United States is iatrogenic,
Exogenous, factitious, all the same thing.
And we’ll talk about a very important scenario
in which you really want to make sure that
you’re very clear about how the adrenals
would die and how a patient with Cushing is
going to present.
And I would try to reinforce that over and
over again and I will make sure that I do
that for you.
If you take prednisone, cortisol, you can
call it cortisol, then you’re going to look
When you take cortisol, who’s being supressed?
The body is fooled.
The ACTH will be supressed and the adrenals
Isn’t that interesting?
So, the patient looks like Cushing in the
Internally, what’s going on with your patient?
Isn’t that fascinating?
Make sure that you’re clear with that.
If you’re not, that’s okay, I’ll keep
repeating, like I have been doing it with
By the time it becomes… by the time we’re
done, it will be part of your subconscious
You want to make sure with this apoplexy that
you immediately relieve the pressure.
It’s an urgency.
In Sheehan, we talked about the pregnant woman
who is-who is having massive haemorrhage and
during that haemorrhage, there’s going to
be pretty massive pituitary infarction.
This is called Sheehan.
She’s going to then present with lack of
the ability to lactate and breastfeed her
And as far as management is concerned, you
want to make sure that she’s able to properly
survive with her stress hormone called?
Apoplexy versus Sheehan.
This is Sheehan.