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Shikhan's syndrome


Shikhan's syndrome (puerperal heart attack of a hypophysis, puerperal necrosis of a hypophysis) — arises in childbed complication cases massive bleeding with development of arterial hypotonia. During pregnancy the sizes of a hypophysis increase, however its blood supply amplifies. Against the background of the arterial hypotonia which developed owing to puerperal bleeding blood supply of a hypophysis sharply decreases — the hypoxia and a necrosis of a hypophysis develop. All adenohypophysis (hypopituitarism) can be involved in process, but laktotrofny cells are most often damaged. Due to the lack of prolactin the lactation stops — breastfeeding becomes impossible. Shikhan's syndrome — the hypopituitarism reason, the second for prevalence, at adults).

Symptoms of the Syndrome of Shikhan:

Clinical symptoms of a syndrome of Shikhan develop quickly: lack of a lactation, involution of mammary glands, weakness, apathy, hypotonia, in the subsequent join them an indumentum oskudneniye, a degrowth of a body and a starvation. In case of lack of timely medical care in the form of precisely established diagnosis and necessary replacement therapy there can come the lethal outcome. At the same time after some time after the delivery under favorable conditions for life spontaneous partial or even complete recovery of function of a hypophysis, recovery of an ovulation, repeated pregnancy and childbirth are possible.
In typical cases diagnosis is simple. Timely diagnosis is late at patients with a slow syndrome of Shikhan though lack of a lactation after the delivery, being followed by a hemorrhage, long decrease in working capacity and disturbance of menstrual function have to suggest an idea of a hypopituitarism.

Reasons of the Syndrome of Shikhan:

The hypovolemia at the time of delivery (as a result of massive blood loss) leads to reduction of a blood-groove in already increased hypophysis. It leads to vasoconstriction and the subsequent heart attack of gland (a white heart attack  with a coagulative necrosis). The first symptom — the sharp termination of a lactation as the acidophilic cells producing prolactin will prevail at present. In several months other symptoms of a hypopituitarism are shown (for example, a secondary amenorrhea because of deficit of gonadotrophins).

Treatment of the Syndrome of Shikhan:

Treatment comes down to therapy of sexual infantility for what the combination of gonadotropic and sex hormones is recommended. Therapy is begun with oestrogenic hormones - folliculin on 5-10 thousand. Piece intramusculary daily or hexestrol on 1 mg in day of per os within a month. It is possible to apply cyclic therapy on Kvatera for 3-4 months. At a positive take of therapy by sex hormones (increase in a uterus, growth of chest glands) cyclic therapy can be alternated to introduction of gonadotrophins.

At moderate oppression of gonadotropic function of a hypophysis it is possible to recommend treatment by synthetic progestins like Infecundinum within 2-3 months (on 1 tablet a day within 21 days with a break of 7 days). This method is based that the entered sexual steroids temporarily switch off function of a hypophysis and after such "rest" activity of the last is stirred up  (effect of return).

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