BN TIN Y KHOA

TRNG HP LM SNG

Trang 22

HI CHNG SHEEHAN BS. Nguyn Hu Hn Chu

BN NGUYEN THI H SN 1956 a ch: vng tu Khm ngy 2/6/2009 L do khm : sng ,nng mt. Bnh s : Sng mt nhiu nm ,bt u iu tr bnh 7-8 nm vi mt cm gic nng, sng, mt mi, n y bng , n chm tiu, thnh thong bn khm nhiu chuyn khoa /nhiu BV vi chn on vim d dy, RL lo u. Cm gic cng, nng mt vn khng ci thin, cm gic lnh, da xanh ti, bng, thnh thong tiu bn, mt tng dn khng lm vic g c (trc y bn lm ngh nng) Tin cn PARA 5005 . Nm 32 tui sanh con t b bng huyt sau sinh ->khng sa cho con b, khng c kinh tr li-> rng lng bpsd v nch dn, gim ham mun... bn khng . Khng dng thuc tu, bc. Khm lm sng M 56 l/pht, HA 10/7 cm/hg, CN 58kg T : 370C tnh 2 m mt trn sng, da bng, xanh ti, hai hng lng my nht.Nhiu np nhn nh vng trn. ph chn nh n khng lm, da kh.Da vng qung v nht nht Vng h nch nhn khng c lng, khng c lng mu Tim nhp 56ln/pht Cc XN Bn lm tng qut: creatinin mu : 1,4mg/dL glucose mu : 93mg/dL. lipid mu: C-TG-HDL-LDL :228-150-40-121mg/dl BC : 5020( N :21%) Hct: 34,5 (91,5-30,8) Hb : 11,6 TC 297.000 Fe 120 (50-168) Ferritin : 639 (15-150) CN gan trong gh bt Indo Na-K-Ca-Cl : 144,3-3,53-1,04-104 TSH 2,91 U/mL FT4: 0,29 ng/dL Cortisol mu 8h sng : 0,02 ANA m tnh TPTNT : Protein m tnh Erythrocyte : m tnh ID : P56835 Ngh nghip: ni tr

Siu m bng : cha pht hin bt thng ECG : 52ln/pht- trc trung gian
Bnh vin Hon M Lu hnh ni b

BN TIN Y KHOA

TRNG HP LM SNG

Trang 23

Siu m tim : EF : 62 t vn : 2 triu chng cha kho :mt sa + khng c kinh nguyt tr lisau sinh suy gip , Suy tuyn thng thn , suy sinh dc chn on s b : Suy tuyn yn do hi chng Sheehan BN c lm thm: ACTH 8h : 4,5(15-100) FSH : 2,23 mU/ml(postmenopause: 40-250) LH : 0,73 mU/ml (postmenopause 20-100) PRL : 3,66 ng/ml(5-40 ) Estradiol : 10pg/ml(45-170) Anti TPO : 29 (< 34) Xq s h yn thng nghing : cha pht hin bt thng vng h yn MRI s no c cn quang: khng thy hnh nh u no.khng thy khi chn ch ni so.tuyn tin yn teo nh, chiu cao khang 0,2 cm, p xung sn tuyn yn, tn hiu bnh thng Chn on xc nh : hi chng Sheehan iu tr : prednisolone 5mg 1,5vin .2 ngy sau dng thm: levothyroxin 50 g Ngy ti khm 24/6 tnh trng lm sng khe hn, bt nng mt M 80 ln/pht, HA 13/8cmHg 17/7 bt u lm vic li FT4 : 0.787ng/dL kt qu xt nghim iu tr Levothyroxin 50g 1,5v prednisolone 5mg 1,5v levothyroxin 100 g 1v prednisolone 5mg 1,5vin 17/8 FT4 : 0.777ng/dL levothyroxin 100 g 1 v prednisolone 5mg 1,5vin 18/9/09 lm ry BT, ht nng mt n ung BT FT4 : 1,3ng/dL levothyroxin 100 g 1 v sng prednisolone 5mg 1,5vin 18/9/09 17/10 lm ry BT, ht nng mt n ung BT FT4 : 1,3ng/dL levothyroxin 100 g 1 v sng prednisolone 5mg 1,5vin 3/12/09 3/1/10 8/4/10 khe, sinh hot bnh thng FT4 : 1,41ng/dL TSH : 0,418 levothyroxin 100 g 1 v sng prednisolone 5mg 1,5vin 1v

Bnh vin Hon M

Lu hnh ni b

BN TIN Y KHOA

TRNG HP LM SNG

Trang 24

Bnh c m t bi H.L Sheehan nm 1937.Tuyn yn thiu mu do truy mch ,do xut huyt, c th phi ct t cung. Tuyn yn giai on cui ca thai k c th tch gia tng, mu n nhiu do nhy vi s gim huyt p d thiu mu. 2 du hiu cha kho trong hi chng Sheehan l khng c sa cho con b sau sanh v khng c kinh tr li sau sanh. HC sheehan c th i din cho suy tuyn yn ngi tr. Suy tuyn yn ngi ln tui c th do tc ng mch tuyn yn. Ngi b hi chng Sheenhan thng c cc biu hin ban u khng r rt, din ra m thm, tin trin t t d b b qua. Khi b thm cc bnh khc nh cc nhim khun, stress, phu thut th hi chng ny s nng ln v c th c cc bin chng sau: Suy thng thn cp,H ng huyt,Ri lon nc in gii nng. Cc bin chng ny c th e do tnh mng nu bnh nhn khng c cp cu kp thi. V vy, tt c nhng ph n mt mu nhiu trong cuc u c nguy c b hi chng Sheenhan. Cc sn ph sau sanh nu khng c kinh nguyt tr li, khng c sa nui con nn n bnh vin pht hin sm v iu tr kp thi.

Bnh vin Hon M

Lu hnh ni b