Sheehan syndrome
Postpartum hypopituitarism; Postpartum pituitary insufficiency; Hypopituitarism syndrome; Sheehan's syndromeSheehan syndrome is a condition that can occur in a woman who bleeds severely during childbirth. Sheehan syndrome is a type of hypopituitarism.
Hypopituitarism
Hypopituitarism is a condition in which the pituitary gland does not produce normal amounts of some or all of its hormones.
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.
The condition is rare today due to advances in obstetric care.
Symptoms
Symptoms of Sheehan syndrome may include:
- Inability to breastfeed (breast milk never "comes in")
- Fatigue
- Lack of menstrual bleeding
- Loss of pubic and armpit (axillary) hair
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Low blood pressure
Low blood pressure
Low blood pressure occurs when blood pressure is much lower than normal. This means the heart, brain, and other parts of the body may not get enough...
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Note: Other than not being able to breastfeed, symptoms may not develop for several years after the delivery.
Exams and Tests
Tests done may include:
- Blood tests to measure hormone levels
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MRI of the head to rule out other pituitary problems, such as a tumor
MRI of the head
A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...
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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: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 1.
Erin K, Aliya K. Other endocrine disorders of pregnancy. In: Lockwood CJ, Copel JA, Dugoff L, et al, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 62.
Huang W, Molitch ME. Pituitary and adrenal disorders in pregnancy. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 48.
Kaiser U, Ho K. Pituitary physiology and diagnostic evaluation. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 8.
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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 rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
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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 rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
Review Date: 11/10/2022
Reviewed By: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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