Nezhat, Nezhat, and Sillen copy in gynecologic practice. Chicago: Year Book, 1986:140. 3. Semm K. In: Friedrich E, ed. Operative manual for endo- scopic abdominal surgery. Chicago: Year Book, 1984. 4. Gjonnaess H. Polycystic ovarian syndrome treated by ovarian electrocautery through the laparoscope. Fertil SteriI1984;41:20-5. 5. Tadir Y, Kaplan 1, Zuckerman Z, et al. New instrumen- tation and technique for laparoscopic carbon dioxide laser operations: a preliminary report. Obstet Gynecol 1984;63:582-5. 6. Bruhat M, Manhes H, Mage G, et aI. Treatment of ectopic pregnancy by means of laparoscopy. Fertil Steril 1980;33:411-4. 7. Semm K. Gynecologic surgical interventions with the lap- aroscope. In: Phillips JM, ed. Endoscopy and gynecology. Downey, California: American Association of Gynecologic Laparoscopists, 1979:514-21. 8. Hulka JP, Herbst AL. Should a unilocular ovarian cyst be aspirated through the laparoscope? Obstet Gynecol Forum 1987;2:1-4. 9. Nezhat C, Winer WK, Nezhat F. Laparoscopic removal of dermoid cysts. Obstet Gynecol 1989;73:278-81. 10. Nezhat C, Winer W, Cooper JD, ezhat F, Nezhat C. Endoscopic infertility surgery. J Reprod Med 1989;34:2. II. Nezhat C, Crowgey S, Nezhat F. Videolaseroscopy for the treatment of endometriosis associated with infertility. Fer- til Steril 1989;51:237-40. November 1991 Am J Obstet Gynecol 12. Nezhat C, Winer WK, Nezhat F. Safe laser excision or vaporization of peritoneal endometriosis. Fertil Steril 1989;52:149-51. 13. Davis GD, Hruby PH. Transabdominal laser colpotomy. J Reprod Med 1989;34:438-40. 14. Nezhat C, Nezhat F, Silfen SL, Schaffer N, Evans D. Lap- aroscopic myomectomy. Int J Fertil 1991 ;36: no 5. 15. Nezhat C, Gordon S, Wilkins E, Silfen SL, Nezhat F. Lap- aroscopic hysterectomy versus abdominal hysterectomy. J Reprod Med 1991 [In press]. 16. Nezhat CR, Nezhat FR, Metzger DA, Luciano AA. Adhe- sion formation after reproductive surgery by videolaser- oscopy. Fertil Steril 1990;53: 1008-11. 17. Operative laparoscopy study group. Postoperative adhe- sion development after operative laparoscopy: evaluation of early second-look procedures. Fertil Steril 1991;55: 700-4. 18. Perry CP, Upchurch JC. Pelviscopic adnexectomy. AM J OBSTET GYNECOL 1990; 162:79-81. 19. Nezhat C, Nezhat F, Silfen S. Videolaseroscopy: the CO 2 laser in advanced operative laparoscopy. Obstet Gynecol Clin North Am 1991;18:565-604. 20. Reich H, Vancaillie TG, Soderstrom RM. Electrical tech- niques. In: Martin D, ed. Manual of endoscopy. Sante Fe, California: Port City Press, 1990: 109-11. 21. Nezhat F, Nezhat C, Winer W. Salpingectomy via lapa- roscopy: a new surgical approach. J Laparoendosc Surg 1991; I :91-5. Inappropriate secretion of antidiuretic hormone in Sheehan's syndrome: A rare cause of postpartum hyponatremia Chaim Putterman, MD,a Yaniv Almog, MD,a Yoseph Caraco, MD,a David J. Gross, MD; and Eldad Ben-Chetrit, MD' Jerusalem, Israel A 27-year-old woman experienced hemorrhagic shock after delivery. One week later she was seen in an obtunded state 01 consciousness. The results of laboratory evaluation were consistent with the syndrome of inappropriate antidiuretic hormone secretion caused by hypopituitarism. Hydrocortisone rapidly corrected sodium levels. Syndrome of inappropriate secretion of antidiuretic hormone caused by Sheehan's syndrome should be considered in the differential diagnosis of postpartum hyponatremia. (AM J OSSTET GYNECOL 1991 ;165:1330-3.) Key words: Antidiuretic hormone, hyponatremia, Sheehan's syndrome Postpartum anterior pituitary necrosis (Sheehan's syndrome) infrequently causes hypopituitarism. Hy- ponatremia is a rare initial manifestation of postpartum pituitary insufficiency, particularly when it occurs within a few days of parturition. We report a case of From the Departments of Internal Medicine A' and Endocrinology and Metabolism,' Hadassah University Hospital, Ein-Kerem. Receivedfor publication March 5,1991; revised April 24, 1991; accepted May 15, 1991. Reprint requests: Chaim Putterman, MD, Department of Internal Medicine A, Hadassah University Hospital, Kiryat Hadassah, POB 12000, Jerusalem, Israel, 91120. 6/I /31190 early Sheehan's syndrome initially seen as severe Ill- appropriate secretion of antidiuretic hormone. Case report A 27-year-old woman complained of headache and weakness. Seven days earlier she had been vaginally delivered of a healthy male infant. Immediately post partum she had an estimated 2 L uterine hemorrhage with shock. She was resuscitated with blood and col- loids; hemorrhage was controlled with uterine massage, oxytocin, and ergotamine. One week after delivery she suddenly had paresthesias, slurred speech, headache, weakness, and somnolence. She also noted new diffi-