An Overview of Sheehan's Syndrome

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Sheehan's syndrome is a rare condition that develops in some women who bleed excessively during childbirth. The extreme loss of blood affects and decreases the function of the pituitary gland, leading the women involved to experience the symptoms of hypopituitarism. In effect, Sheehan's syndrome is a type of hypopituitarism.

The pituitary gland, a part of the endocrine system, is the gland in the body that is responsible for the production of certain hormones that affect organs like the thyroid, kidneys, and sexual reproductive organs like the uterus. When the pituitary gland is damaged and these hormones aren't produced in enough quantity, the function of these other affected organs also declines.

Sheehan's syndrome is also known as postpartum hypopituitarism, postpartum panhypopituitary syndrome, postpartum pituitary necrosis, and postpartum panhypopituitarism.

Symptoms

The symptoms of Sheehan's syndrome varies from person to person and depends on the extent to which the pituitary gland is failing to produce its hormones. Also, its symptoms usually manifest gradually and over a period of time. In rarer and much more serious cases, referred to as acute Sheehan's syndrome, the symptoms appear right after childbirth:

  • Fatigue
  • Dry skin
  • Weight gain
  • Constipation
  • Inability to resume menstruation (amenorrhea)
  • Irregular menstruation (oligomenorrhea)
  • Loss of pubic hair and hair in armpits
  • Low blood pressure
  • Inability to lactate (milk never comes in and the mother is unable to breastfeed)
  • Thinning of the vaginal lining
  • Diabetes insipidus (condition in which the kidneys produce an abnormally huge volume of urine)
  • Loss of strength in muscles
  • Insulin sensitivity
  • Decreased libido (reduced interest in sex)
  • Hot flashes
  • Reduction in size of breasts
  • Fast and/or irregular heartbeat (tachycardia)

Causes

Sheehan's syndrome is caused by excessive blood loss during childbirth that leads to the death of the pituitary gland cells. During pregnancy, the pituitary gland grows bigger, requires more oxygen, and is in a more fragile state than usual.

When a woman bleeds excessively during childbirth, there is a consequent drop in her blood pressure and in the supply of blood (which carries oxygen) to organs like the pituitary gland. This damages the pituitary gland and it’s not able to function properly and produce enough hormones anymore.

There are two lobes in the pituitary gland: the anterior lobe and the posterior lobe.

In the medical community, it is suggested that there has to be at least 75 percent to 90 percent damage done to the anterior pituitary lobe before Sheehan's syndrome develops.

The hormones produced by the anterior lobe that are affected by Sheehan's syndrome are:

  • Prolactin: This is the hormone responsible for stimulating the production of breast milk.
  • Growth hormone: It is responsible for the growth of most cells in the body. It is also responsible for bone growth and maintaining muscle mass.
  • Thyroid stimulating hormone: This hormone stimulates the thyroid to produce the thyroid hormones: thyroxine and triiodothyronine.
  • Follicle stimulating hormone and luteinizing hormones: These hormones are called gonadotropins. They stimulate and regulate the functions of the ovaries.
  • Adrenocorticotropic hormone: This hormone regulates the production of glucocorticoids like cortisol by the adrenal cortex.

Risk Factors

The risk factors for developing Sheehan's syndrome are basically things that can increase your risk of hemorrhaging (bleeding severely and excessively) during childbirth. These include:

  • having a multiple baby pregnancy
  • having a placental disorder like placenta accreta or placenta previa

Diagnosis

A diagnosis of Sheehan's syndrome is usually made when a woman has symptoms of hypopituitarism as well as a medical history of excessive bleeding during childbirth. The doctor may also order blood tests to measure the levels of the pituitary gland hormones to confirm the diagnosis.

Additionally, an MRI or CT scan may be ordered to obtain images of the pituitary gland and rule out the possibility of other pituitary problems like a tumor, as pituitary tumors are the primary cause of hypopituitarism and its attendant symptoms.

In situations where the Sheehan's syndrome is acute and the symptoms start to show immediately, a diagnosis will be made before the woman leaves the hospital and treatment will be started right away.

Treatment

Sheehan's syndrome is treated the same way regular hypopituitarism is treated—with hormone replacement therapy. The doctor will evaluate the hormone levels in the patient and determine which ones need hormone replacement therapy, as this varies from individual to individual.

  • Estrogen and progesterone: This is usually taken until the age of menopause, at which point the doctor will evaluate if it is still needed. In cases where the woman has had a hysterectomy (removal of the uterus) the only estrogen will be prescribed. The prescription of oral contraceptives is one of the common ways these hormones are replaced.
  • Thyroxine: This is used to replace the thyroid hormone.
  • Cortisones like prednisone and hydrocortisone: These are used to replace the adrenocorticotropic hormones (ACTH).
  • Growth Hormone (GH): Your doctor may also prescribe this to help increase muscle mass, lower your cholesterol levels, and generally make you feel better.

A Word From Verywell

If you suspect you have Sheehan's syndrome, you should go and see your doctor immediately. If left untreated, this condition can be very dangerous. However, If you’ve been diagnosed with Sheehan's syndrome, you should know that most hormone replacement therapies are successful, especially if the diagnosis was made early. If you have Sheehan's syndrome and you wish to have children in future, it is important that you discuss your fertility options extensively with your doctor, and if you can afford it, you should see a reproductive endocrinologist—a doctor that specializes in fertility.

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