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Sheehan syndrome

Definition

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

Alternative Names

Postpartum hypopituitarism; Postpartum pituitary insufficiency; Hypopituitarism syndrome; Sheehan's syndrome

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
• Low blood pressure

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
• 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: 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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