Overview
Sheehan syndrome is also called postpartum hypopituitarism or postpartum pituitary necrosis. Sheehan’s syndrome occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage i.e, severe blood loss during childbirth causes long-term damage to your pituitary gland. A damaged pituitary gland can’t produce enough of the hormones your body needs to function. Sheehan syndrome is rare but treatable with medication.
If you have Sheehan syndrome, severe blood loss deprives your pituitary gland of the oxygen it needs to work properly. As a result, some of the tissue in your pituitary gland dies.
Your pituitary gland sits at the base of your brain. It grows during pregnancy, making it susceptible to injury. Damage to your pituitary gland can have widespread effects on your body because it’s a “master gland.” Not only does your pituitary gland secrete hormones that spur important processes in your body, but it also tells other glands to secrete hormones. Your pituitary gland helps regulate processes that impact your brain, reproductive system, muscles, skin, energy and mood.
Sheehan syndrome is unfortunately most common in developing nations like India. Sheehan syndrome can be life-threatening if you don’t get treated. With long-term hormone therapy, you should be able to live a healthy, normal life. Due to advances in medical care, Sheehan syndrome is very rare but treatable with medications.
Causes
Severe blood loss during childbirth causes Sheehan syndrome. Your pituitary gland grows during pregnancy and can even double in size. The size increase makes it especially vulnerable to injury if it doesn’t get enough oxygen. Losing too much blood or experiencing a severe drop in blood pressure during childbirth deprives your pituitary gland of the oxygen it needs to stay healthy.
As a result of this damage, your pituitary gland can’t produce enough of the hormones you need to regulate certain body functions. Insufficient hormones can negatively impact several of your body’s common functions. Hormone deficiencies resulting from a pituitary gland injury can slow or stop processes related to your reproductive system, nervous system and more.
Symptoms
The symptoms of Sheehan syndrome sometimes start right after childbirth. Or, they can come on gradually months or even years later. Women who have very little damage to their pituitary gland might not develop symptoms for several years.
Symptoms of Sheehan syndrome include:
- difficulty breastfeeding or an inability to breastfeed
- irregular menstrual periods (oligomenorrhea) or no periods (amenorrhea)
- weight gain
- intolerance to cold
- slowed mental function
- loss of pubic and underarm hair
- fatigue or weakness
- fine wrinkles around the eyes and lips
- breast shrinkage
- dry skin
- joint pain
- decreased sex drive
- low blood sugar
- low blood pressure
- irregular heartbeat
Factors
Factors that make you more likely to have severe blood loss include:
- placental abruption, when the placenta that nourishes the unborn baby detaches from the uterus
- placenta previa, when the placenta partly or totally covers the cervix (the bottom part of the uterus that connects to the vagina)
- giving birth to a large baby, who weighs more than 8.8 pounds (4,000 grams), or having multiples, like twins
- preeclampsia, high blood pressure during pregnancy
- assisted labor, a forceps or vacuum-assisted delivery
Diagnosis and Tests
- Medical history. Tell your provider about any blood loss or other complications you experienced during previous childbirths. Let them know about any symptoms afterward (for instance, having trouble producing breast milk or not getting a menstrual period). Tell your provider about any symptoms you’re experiencing, including when they occur and what improves them.
- Blood tests. Your provider will take a sample of your blood and check the hormone levels that relate to your pituitary gland’s functioning.
- Imaging tests. An MRI (magnetic resonance imaging) can allow your provider to rule out other causes of your symptoms, like a tumor on your pituitary gland. They may order a CT scan (computed tomography scan) if the MRI results are inconclusive.
Treatment & Management
Treatment for Sheehan syndrome is to take the hormones your body no longer produces. You’ll need to stay on most of these hormones for life:
- Corticosteroids. Prednisone or hydrocortisone replaces adrenal hormones.
- Levothyroxine (Levoxyl, Synthroid). This medication increases the levels of the hormones your thyroid gland makes.
- Estrogen plus progesterone (or estrogen alone, if your uterus has been removed). These female hormones help normalize your menstrual cycle. You can stop taking them once you reach the age of menopause.
- LH and FSH. These hormones stimulate ovulation and can help you get pregnant.
- Growth hormone. This hormone helps maintain bone density, improves your body’s ratio of muscle to fat, and lowers cholesterol levels. A specialist called an endocrinologist will oversee your treatment. You’ll have regular blood tests to check your hormone levels.
Prognosis
With treatment, the prognosis for Sheehan syndrome is excellent. Most people don’t have serious complications. Many have successful pregnancies following their diagnosis, with careful observation from their care team. You’ll need to see your endocrinologist for regular checkups to ensure that you’re receiving the right amount of medication you need to make up for any hormone deficiencies. Part of your follow-up care will involve regular blood draws to check hormone levels.
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