Why is the hair down there falling off?

In daily life, many female friends suffer from the trouble of hair loss. This situation not only causes great harm to their physical health, but also seriously affects their normal life and work. Therefore, it is particularly important to understand relevant knowledge and find scientific and effective treatment methods. If you find any related symptoms, you need to seek medical treatment in time to recover your health as soon as possible.

Pubic hair loss

reason

Due to postpartum hemorrhage, especially accompanied by prolonged hemorrhagic shock, the pituitary tissue suffers from hypoxia, degeneration and necrosis, followed by fibrosis, and eventually leads to a syndrome of pituitary dysfunction, the incidence of which accounts for about 25% of patients with postpartum hemorrhage and hemorrhagic shock. Studies in recent years have shown that the occurrence of Sheehan's syndrome is not only related to hypopituitarism. Otsuka reported that 40% of patients showed signs of hypofunction of the entire adenohypophysis, and 50% of them showed varying degrees of abnormality in neurohypophysis function.

examine

If there is a history of postpartum hemorrhage or shock, the above typical clinical manifestations and signs combined with laboratory tests can confirm the diagnosis.

Laboratory tests:

1. Pituitary hormone tests show that GH, FSH, LH, ACTH, and PRL are decreased.

2. Thyroid hormone tests show that TT3, TT4, T3, T4, and TSH are reduced.

3. Adrenal hormone tests showed that cortisol, urine 17-hydroxy, and 17-ketone decreased, and fasting blood sugar decreased.

4. Sex hormone testing showed that estrogen, progesterone, and testosterone propionate were all reduced.

5. Routine blood tests often show a decrease in hemoglobin, red blood cells, and hematocrit.

6. Immunological tests have not yet confirmed that the occurrence of Sheehan syndrome is related to autoimmunity. Immunological tests have shown that the patient's blood tests are negative for anti-pituitary antibodies and pituitary peroxidase antibodies.

7. Determination of pituitary reserve function

(1) Thyrotropin-releasing hormone (TRH) stimulation test: The principle is that TRH can stimulate the anterior pituitary to produce TSH and PRL. 100-200 g of TRH is dissolved in 2 ml of normal saline and injected intravenously. 3 ml of blood is drawn before injection and 15, 30, and 60 minutes after injection to measure the baseline values ​​of TSH and PRL and the changes in these values ​​after medication. Results: Normally, TSH reaches its peak 20 to 30 minutes after injection, with a peak value of 6.5 to 20.5 min/L. If there is no obvious increase after TRH injection, it indicates insufficient pituitary reserve function. The basic level of PRL is 25g/L, which rises to 40g/L 30 minutes after the injection of TRH. If there is no obvious increase or the increase is not obvious, it indicates pituitary insufficiency.

(2) Luteinizing hormone (LH) stimulation test: Dissolve 50-100 g of LHRH in 5 ml of normal saline and inject intravenously. Draw 3 ml of blood before injection and 15, 30, 60, and 90 minutes after injection. Determine FSH and LH by radioimmunoassay. In normal subjects, FSH and LH increase 2 to 4 times 30 minutes after injection. If there is no reaction, it indicates poor pituitary function.

8. Other blood tests showed low blood sugar, low hemoglobin, and high eosinophil count.

Other auxiliary examinations:

1. Imaging examination Ultrasound examination can show uterine atrophy, smaller ovaries, no follicle development, and no ovulation. Cranial X-rays showed no significant changes in the sella turcica. Cranial CT and MRI showed that the pituitary gland had atrophied and shrunk. MRI showed that in 83% of patients, although the pituitary gland was discernible, its density was significantly reduced, and even a cavity echo was shown in the sella turcica area, which was called a hollow sella turcica.

2. Other basal body temperature drops, showing a single phase. Electrocardiogram, echocardiogram, and cardiac function tests may show signs of myocardial ischemia.

3. Vaginal smear shows low estrogen levels.

4. Urine examination showed that 17-KS and 17-OH in urine were significantly reduced within 24 hours.

Differential Diagnosis

Identifying the confusing symptoms of pubic hair loss

1. Prolactinoma: It is the most common pituitary tumor. It is an endocrine disease caused by excessive secretion of prolactin (PRL) by pituitary prolactin cell tumors. The main clinical manifestations are hyperprolactinemia, galactorrhea or galactorrhea-amenorrhea syndrome. It is more common in women aged 20 to 30 and less common in men.

2. Sheehan syndrome: Hypopituitarism is also known as Sheehan syndrome. Sheehan syndrome is a common pituitary disease that occurs in women of childbearing age, and most women have a history of postpartum hemorrhage and shock. Sheehan syndrome can occur not only in vaginal births, but also after cesarean sections. In Sheehan syndrome, gonadal function is impaired, the female ovaries are significantly reduced, and the uterus and breasts atrophy.

3. Primary hypothyroidism In primary hypothyroidism, in addition to insufficient thyroid function, the functions of other endocrine glands may also be low, and thus it can be mistaken for hypopituitarism. The two can be differentiated by the fact that in primary hypothyroidism the myxedema is more pronounced in appearance, the blood cholesterol concentration is more significantly increased, and the heart is often enlarged. TSH stimulation test: Primary hypothyroidism will cause TSH excessive reaction, adenohypophysial hypothyroidism may not cause TSH elevation reaction, and hypothalamic hypothyroidism will show a delayed reaction. The most discriminatory test is the plasma thyroid-stimulating hormone measurement, which is elevated in primary hypothyroidism but undetectable in hypopituitarism.

4. Chronic adrenocortical insufficiency The difference between chronic adrenocortical insufficiency and hypopituitarism is that the former has typical skin and mucous membrane pigmentation, while the manifestations of sexual organ atrophy and hypothyroidism are not obvious, it does not respond to adrenocorticotropic hormone, and the sodium loss phenomenon is relatively serious.

5. Autoimmune polyendocrine syndrome. Patients with this syndrome have multiple manifestations of endocrine gland dysfunction, but the cause is not due to hypopituitarism, but due to the primary dysfunction of multiple endocrine glands. The differentiation from adenohypophysis is mainly based on adrenocorticotropic hormone and thyroid-stimulating hormone stimulation tests. In this syndrome group, there is no reaction, while in adenohypophysis, there is often a delayed reaction.

Mitigation methods

Prevention of pubic hair loss

1. At the beginning of pregnancy, we should pay attention to the overall condition of the pregnant woman, strengthen nutrition, supplement vitamins and iron, correct anemia, and supplement hormones as appropriate according to the patient's specific situation to ensure that all organs of the pregnant woman are in the best functional state throughout the pregnancy. In the late pregnancy, in order to enable the body to have sufficient stress resistance to deal with the upcoming delivery and possible complications during delivery, thyroid powder (thyroxine) and prednisone should be given. Those who are taking hormones during pregnancy should increase the dosage appropriately to increase their stress resistance. The preferred mode of delivery is elective cesarean section to prevent postpartum hemorrhage. If postpartum hemorrhage occurs, it should be treated actively with large amounts of rapid blood transfusion and intravenous drip of large amounts of cortisone. If conservative treatment is ineffective and bleeding cannot be controlled, the uterus should be removed immediately.

2. For those who have Sheehan syndrome and have been treated or whose condition is mild and who are pregnant again, this high-risk factor should be taken seriously and they should be under the joint supervision of obstetricians and endocrinologists throughout the pregnancy. Because the placenta can produce many hormones after pregnancy, the symptoms of most patients improve or disappear during pregnancy, so hormone replacement or supplementary treatment is not necessarily required. However, during pregnancy, you must be alert to any factors that may induce pituitary crisis. For example, severe vomiting and inability to eat in early pregnancy can lead to hypopituitarism-related hypoglycemia coma. Trauma, infection, surgery and other stressful situations during pregnancy often prevent the hypofunctioning pituitary gland from adapting, resulting in pituitary crisis or even death.