Sheehan’s syndrome (Postpartum hypopituitarism)
Sheehan's syndrome is postpartum hypopituitarism caused by necrosis of the pituitary gland.
- It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery.
Risk factors
- Increased chance of severe blood loss, at the time of childbirth is the most likely cause. Following are most associated risk factors-
- Abruptio placentae
- Placenta previa
- Multiple pregnancy
- Pre-eclampsia
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Pathogenesis
- Important causes of postpartum pituitary necrosis include severe hemorrhage during and before parturition. The blood supply to the already enlarged pituitary gland is seriously compromised after excessive bleeding. The enlarged gland is more susceptible to tissue hypoperfusion and infarction.
- It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery. Anterior pituitary hormone deficiency is more pronounced.
secretion of following is most affected-
- prolactin
- growth hormone
- cortisol secretion
- gonadotropin
- thyroid stimulating hormone (TSH)
Clinical Features
- Lactation failure (earliest sign)
- Secondary Amenorrhea
- Hypogonadism
- Asthenia and weakness
- Loss of hair
- Hypopigmentation
- Diabetes insipidus
- Empty Sella in MRI report
Diagnosis
- History of postpartum hemorrhage, failure to lactate and secondary amenorrhea are most important clue for diagnosis. Main radiological finding on MRI is empty Sella (because of pituitary necrosis).
Treatment
- Goal is to replace deficient hormones.
Case Scenario
- A 25-year-old woman presents to her obstetrician 2 weeks postpartum for failure to lactate. She feels tired all the time and unable to tolerate cold environments since the birth of her child. Her delivery was complicated by placenta Previa with postpartum blood loss. Her newborn infant is doing well on formula milk. She doesn’t have family history of thyroid disease. Physical exam is overall unremarkable. What is most likely diagnosis?
- Revision for Today https://creativemeddoses.com/topics-list/hepatocellular-carcinoma-hcc/
- Further reading https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183525/