Sheehan Syndrome/Postpartum Hypopituitarism

Definition
Sheehan syndrome is a condition in which there is excess bleeding in women during childbirth.

In Sheehan syndrome severe blood loss deprives the body of oxygen which can lead to serious damage to vital tissues and organs.

Sheehan’s syndrome damages the pituitary gland — a small gland at the base of brain. Sheehan’s syndrome occurs due to necrosis of the anterior lobe of the pituitary gland because of severe drop in women’s blood pressure.

Sheehan syndrome is not inherited .

During pregnancy there is an increased amount of hormone oestrogen in the body which increases the size of pituitary gland and volume of blood flow , which makes the pituitary gland more vulnerable to damage from loss of blood. If heavy bleeding occurs during or immediately after childbirth, there will be a sudden decrease in the blood supply to the already vulnerable pituitary gland. This can cause tissue death and subsequent loss of pituitary function.
Causes of Sheehan Syndrome/Postpartum Hypopituitarism

During childbirth excess bleeding cause’s tissue death in the pituitary gland. The pituitary gland is located at the base of the brain. Pituitary gland produces hormones that stimulate breast milk production, growth, reproductive functions, the thyroid, and the adrenal glands.

Sheehan’s syndrome is caused by severe blood loss during/ after childbirth. This excess blood loss can be particularly damaging to the pituitary gland, destroying hormone-producing tissue.

Pituitary gland secretes following hormones -
• Growth hormone (GH)-Hormone controls bones and tissue growth.

• Anti-diuretic hormone (ADH).

• Thyroid-stimulating hormone (TSH). It stimulates thyroid gland to produce hormones that regulate metabolism.

• Luteinizing hormone (LH). LH regulates testosterone production in men and in women estrogen.

• Follicle-stimulating hormone (FSH). FSH stimulates sperm production in men, and egg development and ovulation in women.

• Adrenocorticotropic hormone (ACTH). This hormone stimulates adrenal glands to produce cortisol. Cortisol helps your body deal with stress and influences many body functions, including blood pressure, heart function and your immune system.

• Prolactin. This hormone regulates the production of breast milk.

Sheehan Syndrome/Postpartum Hypopituitarism Signs and Symptoms plus

• Inability to breast-feed
• Fatigue, weight loss
• Lack of menstrual bleeding
• Loss of hair
• Low blood pressure
Constipation
• Intolerance to cold
• Low blood sugar level
Anemia
• Low sodium level
• Slowed mental function, weight gain and difficulty staying warm, as a result of an underactive thyroid (hypothyroidism)

Investigations Sheehan Syndrome/Postpartum Hypopituitarism

• Complete history , medical examination
• Blood tests for checking pituitary hormone level
• MRI /CT

Treatment for Sheehan Syndrome/Postpartum Hypopituitarism

• Hormone replacement therapy (estrogen and progesterone)
• Corticosteroids (hydrocortisone or prednisone)

Complications of Sheehan Syndrome/Postpartum Hypopituitarism

• This condition can be life threatening if not treated.
• The most serious complication is adrenal crisis, and a state that can lead to extremely low blood pressure, shock, coma and death.
• High cholesterol
• Menstrual irregularities