[A study of risk factors of psychiatric symptoms occurring in treating Sheehan's syndrome patients].

OBJECTIVE

To investigate the risk factors of psychiatric symptoms in the process of the treatment of Sheehan's Syndrome (SS).

METHODS

We collected the clinical data of 119 inpatients diagnosed of SS in Department of Endocrinology, the Second Xiangya Hospital, Central South University from January 2002 to November 2014. Logistic regression analyses were applied to investigate the risk factors of psychoses during the treatment of SS.

RESULTS

We found that among all the 119 subjects, 64 (54%) out of the pathients developed into pituitary crisis over the course of treatment for SS. And, 42 (35%) of the patients had psychiatric symptoms. SS patients with psychiatric symptoms had lower levels of hemoglobin [(96 ± 16) g/L vs (104 ± 23) g/L, (P < 0.05)], sodium [(117 ± 12) mmol/L vs (127 ± 12) mmol/L, (P < 0.01)], free serum T3 (FT3) [(1.4 ± 1.0) pmol/L vs (2.1 ± 1.3) pmol/L, (P < 0.01)] and free serum T4 (FT4) [(4.1 ± 2.8) pmol/L vs (6.5 ± 4.9) pmol/L, (P < 0.05)], but higher levels of daily dosage of hydrocortisone for the first three days (P < 0.05) compared to the group without the same. Upon occurrence of psychiatric symptoms, the daily dosage of hydrocortisone for the first three days was 165 mg. Among them, patients also with pituitary crisis had a higher requirement of hydrocortisone, that is, daily dosage of hydrocortisone for the first three days was 208 mg. Logistic regression analysis showed that sodium (P < 0.05, OR < 1) and hydrocortisone dosage of the first day (P < 0.01, OR > 1) were included in the logistic regression equation, suggesting that serum sodium, is a protective factor against psychiatric symptoms (OR = 0.950). And the dosage of glucocorticoid required on the first day (OR = 1.008) is a risk factor for psychiatric symptoms.

CONCLUSION

SS patients with severe anterior pituitary dysfuncthion, especially those with pituitary crisis are susceptible to have psychiatric symptoms during glucocorticoid treatment. The dosage of glucocorticoid, especially the first day dosage is one of the risk factors for psychiatric symptoms.