Journal of Guilan University of Medical Sciences
مجله علوم پزشکی گیلان
JGUMS
Literature & Humanities
http://journal.gums.ac.ir
1
admin
2383-4307
2423-4818
10.32598
fa
jalali
1371
1
1
gregorian
1992
4
1
1
1
online
1
fulltext
fa
بیماری شیهان گزارش هفده مورد از رشت
تخصصي
Special
پژوهشي
Research
<strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">در یک دوره هشت ساله ، </span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۱۳۵۹ - ۱۳۶۶</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> ، در جریان طبابت در شهر رشت هفده مورد بیماری شیهان مشاهده شده سن آنان در هنگام زایمان توام با شوک خونریز </span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۷</span></span></span></strong><strong><span style="color:black;"><span style="font-family:arial,sans-serif;"><span style="font-size:10.0pt;">±</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> ۳۰ </span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">میانگین </span></span></span></strong><strong><span style="color:black;"><span style="font-family:arial,sans-serif;"><span style="font-size:10.0pt;">±</span></span></span></strong> <strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۱</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> انحراف معیار )سال و در هنگام مراجعه </span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">10</span></span></span></strong><strong><span style="color:black;"><span style="font-family:arial,sans-serif;"><span style="font-size:10.0pt;">±</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">41</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> سال است .ضعف عمومی ، رنگ پریدگی وآمنوره سه علت شایع مراجعه این بیماران است . نه نفرتوسط همکاران دیگر با تشخیص بیماری شیهان (</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۴</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">نفر ) هیپوتیروئیدی (</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۳</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> نفر) ، هیپوگلیسمی (</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۱</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> نفر )، و اغماء (</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۱</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> نفر) معرفی شده بودند، در معاینه همه بیماران تقریبا" تمام تظاهرات کم کاری همه جانبه هیپوفیز را داشتند . سطح 144 سرم مساوی </span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۱/۳</span></span></span></strong><strong><span style="color:black;"><span style="font-family:arial,sans-serif;"><span style="font-size:10.0pt;">±</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۲ (</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">میانگین</span></span></span></strong><strong><span style="color:black;"><span style="font-family:arial,sans-serif;"><span style="font-size:10.0pt;">±</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">1 انحراف معیار، حدود طبیعی(</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۴-۱۲) </span></span></span></strong><strong><span dir="LTR"><span style="color:black;"><span style="font-family:arial,sans-serif;"><span style="font-size:10.0pt;">mcg / dl</span></span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> ، سطح </span></span></span></strong><strong><span dir="LTR"><span style="color:black;"><span style="font-family:arial,sans-serif;"><span style="font-size:10.0pt;">TSH</span></span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> سرم </span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">7</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">/</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">1</span></span></span></strong><strong><span style="color:black;"><span style="font-family:arial,sans-serif;"><span style="font-size:10.0pt;">±</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> ۲</span></span></span></strong> <strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">(میانگین</span></span></span></strong><strong><span style="color:black;"><span style="font-family:arial,sans-serif;"><span style="font-size:10.0pt;">±</span></span></span></strong> <strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۱</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">انحراف معیار ، حدود طبیعی تا</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۵)</span></span></span></strong><strong><span dir="LTR"><span style="color:black;"><span style="font-family:arial,sans-serif;"><span style="font-size:10.0pt;">u/ml</span></span></span></span></strong><strong><span style="color:black;"><span style="font-family:arial,sans-serif;"><span style="font-size:10.0pt;">µ</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> و سطح کورتیزول پلاسما </span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">7</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">/</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">2 - 5/3 (</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">میانگین </span></span></span></strong><strong><span style="color:black;"><span style="font-family:arial,sans-serif;"><span style="font-size:10.0pt;">±</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> 1 انحراف معیار ، حدود طبیعی </span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۹ - ۲۴ ) </span></span></span></strong><strong><span dir="LTR"><span style="color:black;"><span style="font-family:arial,sans-serif;"><span style="font-size:10.0pt;">dl</span></span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> / </span></span></span></strong><strong><span dir="LTR"><span style="color:black;"><span style="font-family:arial,sans-serif;"><span style="font-size:10.0pt;">mcg</span></span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> بود.</span></span></span></strong><strong><span style="font-family:b zar;"><span style="font-size:10.0pt;"></span></span></strong><br>
<strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">پس از دو هفته درمان مقدماتی با حدود </span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۳۰</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> میلیگرم پردنیزولون در روز ، درمان با دوز کم لووتیروکسین سدیم، </span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۲۵</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> تا </span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۵۰</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> میلیگرم در روز شروع شد و به تدریج هر </span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۴-6</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> هفته دوز آن به مقدار </span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۲۵</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> میکروگرم در روز افزایش یافت تا به دوز جانشینی حدود </span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">8/1</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> میکروگرم به ازاء هر کیلوگرم وزن بدن در روز رسید و در همین مدت دوز پردنیزولون هم به تدریج کاهش یافت تا به دوز جانشینی </span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">۵</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> تا </span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">5</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">/</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;">7</span></span></span></strong><strong><span style="color:black;"><span style="font-family:b zar;"><span style="font-size:10.0pt;"> میلیگرم در روز رسید . برای ایجاد قاعدگی و تامین استروژن لازم از مواد استروژنی توام با پروژستوژن استفاده میشود .</span></span></span></strong>
<strong>SUMMARY</strong><br>
During eight years, 1359-1366, seventeen cases with Sheehan's disease was seen. The age of the patients at the time of postpartum hemorrhagic shock was 30±7( mean± 1 SD ) years and at admission was 41 ± 10 ( mean ± 1 SD) years . weakness , palor, and Amenorrhe a was the three most common presenting complaints . Nine patients was referred with the diagnosis of Sheehan's disease (4 cases), hypothyroidism ( 3 cases ), hypoglycemia ( 1 cases), and coma ( 1 cases ).<br>
Clinially all of the patients had almost all the symptoms and signs of panhypopituitarism. Serum T<sub>4</sub> was 2 ± 1.3 ( mean - 1 SD , normal range 4 - 12) mcg/dl , Serum TSH was 2 ±1.7 (mean ± 1 SD , normal range up to 5)/µ/ml, plasma cortisol was 3.5 ± 2.7 , normal range 4 - 24 ) mcg/dl.<br>
After two weeks treatment with about 30 mg prednesolone per day treatment with levothyraxine was begun ; first with 25to 50 mcg daily , The 25 mcg increment perday every 4 to 6 weeks , till The replacement dose of about 1.8 mcg/kg/dug was achieved . Mean while the dose of prednesolone was tapered down to 5 to 7.5 mg a day. For replacement of estrogen and inducing menstural cycles, combiened estrogen and progestogen therapy can be instituted.
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http://journal.gums.ac.ir/browse.php?a_code=A-10-1-364&slc_lang=fa&sid=1
دکتر محمد حسن
هدایتی امامی
Yes
استادیار داخلی - دانشگاه علوم پزشکی گیلان- بیمارستان دکترحشمت رشت
دکتر عباس
قنبری
No
استادیار داخلی - دانشگاه علوم پزشکی گیلان- بیمارستان دکترحشمت رشت