{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:41:06Z","timestamp":1787496066385,"version":"build-2736575974"},"reference-count":22,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T00:00:00Z","timestamp":1700438400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To identify the symptoms and relevant factors associated with acute adrenal insufficiency of early\u2010onset Sheehan syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed the charts of 125 women admitted to our intensive care unit because of postpartum hemorrhage between January 2011 and December 2021. Three women developed acute adrenal insufficiency. We investigated the total blood loss, shock status, consciousness level upon arrival, and intensive care provided to the women. We also analyzed the symptoms and laboratory data that led to the diagnosis of acute adrenal insufficiency. Continuous variables were presented by median (minimum\u2013maximum).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The medians and ranges of age, total blood loss, and shock index [heart rate\/systolic blood pressure] on admission were 33.1 (17.2\u201345.3) years, 3351 (595\u201320\u2009260) g, and 0.94 (0.55\u20132.94), respectively. Seven women were older than 40\u2009years, 28 experienced &gt;5000\u2009g blood loss, 17 had shock index &gt;1.5, 27 had impaired consciousness upon arrival, and 15 underwent hysterectomy. Women who developed acute adrenal insufficiency were &lt;40\u2009years old and had a bleeding volume of over 5000\u2009g, impaired consciousness upon arrival, and had undergone hysterectomy. They had experienced lactation failure, presented with hyponatremia\u2010related symptoms on\u00a0postpartum\u00a0days 8\u20139, experienced general malaise, headache, and impaired consciousness, and showed severe hyponatremia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Massive postpartum hemorrhage over 5000\u2009g, impaired consciousness upon arrival, and hysterectomy as a hemostatic measure were relevant factors associated with acute adrenal insufficiency of early\u2010onset Sheehan syndrome. Hyponatremia\u2010related symptoms occurring after lactation failure are indicative of the onset of acute adrenal insufficiency.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jog.15838","type":"journal-article","created":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T13:35:00Z","timestamp":1700660100000},"page":"205-211","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Postpartum acute adrenal insufficiency of early\u2010onset Sheehan syndrome: A case series study in a single center"],"prefix":"10.1111","volume":"50","author":[{"given":"Shota","family":"Ishikawa","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Chiba University Hospital Chiba 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Obstetrics and Gynecology Chiba University Hospital Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Okayama","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Chiba University Hospital Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emiri","family":"Nakada","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Chiba University Hospital Chiba Japan"},{"name":"Department of Obstetrics and Gynecology Graduate School of Medicine, Chiba University Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0514-2732","authenticated-orcid":false,"given":"Akiko","family":"Omoto","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Chiba University Hospital Chiba Japan"},{"name":"Department of Obstetrics and Gynecology Graduate School of Medicine, Chiba University Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7247-2205","authenticated-orcid":false,"given":"Makio","family":"Shozu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Chiba University Hospital Chiba Japan"},{"name":"Department of Obstetrics and Gynecology Graduate School of Medicine, Chiba University Chiba Japan"},{"name":"Evolution and Reproductive Biology, Medical Mycology Research Center Chiba University Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5057-4120","authenticated-orcid":false,"given":"Kaori","family":"Koga","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Chiba University Hospital Chiba Japan"},{"name":"Department of Obstetrics and Gynecology Graduate School of Medicine, Chiba University Chiba 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