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A case of Sheehan's syndrome with delirium
Author(s) -
UMEKAWA TSUNEKAZU,
YOSHIDA TOSHIHIDE,
SAKANE NAOKI,
KONDO MOTOHARU
Publication year - 1996
Publication title -
psychiatry and clinical neurosciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.609
H-Index - 74
eISSN - 1440-1819
pISSN - 1323-1316
DOI - 10.1111/j.1440-1819.1996.tb00574.x
Subject(s) - hyponatremia , delirium , apathy , medicine , pediatrics , coma (optics) , level of consciousness , abscess , psychiatry , anesthesia , surgery , disease , physics , optics
A 53 year old woman was brought to a psychiatric clinic because of delirium. Upon immediate examination, severe hyponatremia (105 mEq/L) was detected. She was suspected of having internal diseases and referred to our university hospital. When she reached our hospital she was delirious and showed excitement and agitation. Her electroencephalogram showed low voltage θ waves (20 μV) in all leads. She was hospitalized and diagnosed with acute tonsillar abscess and panhypopituitarism based on various endocrine tests. Her past history suggested that Sheehan's syndrome had developed after child‐bearing at age 31, resulting in panhypopituitarism. After administration of antibiotics, the fever and tonsillar abscess gradually recovered, and the correction of electrolytes improved the level of consciousness, suggesting that the hyponatremia had been closely related to the clouding of consciousness. As the subsequent administration of Cortisol kept the patient's serum sodium levels within the normal range, a decrease in plasma Cortisol seemed to be the major cause of the hyponatremia. Psychological symptoms of panhypopituitarism often included abulia, apathy and occasionally coma. However, it is rare for a patient with panhypopituitarism to be misdiagnosed as having a psychiatric disease with delirium. This rare case is presented.