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Sheehan syndrome

Postpartum hypopituitarism; Postpartum pituitary insufficiency; Hypopituitarism syndrome

 

Sheehan syndrome is a condition that can occur in a woman who bleeds severely during childbirth. Sheehan syndrome is a type of hypopituitarism.

Causes

 

Severe bleeding during childbirth can cause tissue in the pituitary gland to die. This gland does not work properly as a result.

The pituitary gland is at the base of the brain. It makes hormones that stimulate growth, production of breast milk, reproductive functions, the thyroid, and the adrenal glands. A lack of these hormones can lead to a variety of symptoms. Conditions that increase the risk of bleeding during childbirth and Sheehan syndrome include multiple pregnancy (twins or triplets) and problems with the placenta. The placenta is the organ that develops during pregnancy to feed the fetus.

It is rare condition.

 

Symptoms

 

Symptoms of Sheehan syndrome may include:

  • Inability to breast-feed (breast milk never "comes in")
  • Fatigue
  • Lack of menstrual bleeding
  • Loss of pubic and axillary hair
  • Low blood pressure

Note: Other than not being able to breast feed, symptoms may not develop for several years after the delivery.

 

Exams and Tests

 

Tests done may include:

  • Blood tests to measure hormone levels
  • MRI of the head to rule out other pituitary problems, such as a tumor

 

Treatment

 

Treatment involves estrogen and progesterone hormone replacement therapy. These hormones must be taken at least until the normal age of menopause. Thyroid and adrenal hormones must also be taken. These will be needed for the rest of your life.

 

Outlook (Prognosis)

 

The outlook with early diagnosis and treatment is excellent.

 

Possible Complications

 

This condition can be life threatening if not treated.

 

Prevention

 

Severe loss of blood during childbirth can often be prevented by proper medical care. Otherwise, Sheehan syndrome is not preventable.

 

 

References

Burton GJ, Sibley CP, Jauniaux ERM. Placental anatomy and physiology. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 1.

Kaiser U, Ho KKY. Pitutary physiology and diagnostic evaluation. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 8.

Molitch ME. Pitutary and adrenal disorders in pregnancy. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 43.

Nader S. Other endocrine disorders of pregnancy. In: Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore TR, Greene MF, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 61.

 
  • Endocrine glands

    Endocrine glands - illustration

    Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

    Endocrine glands

    illustration

    • Endocrine glands

      Endocrine glands - illustration

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Sheehan syndrome

           

             

            Review Date: 10/4/2016

            Reviewed By: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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