Sheehan’s Syndrome

Definition

Sheehan’s syndrome is a rare medical problem that affects women who loses an excessive amount of blood or those who have a severely low blood pressure during pregnancy, or after the delivery of the baby. The pituitary gland together with the hypothalamus is responsible for managing the hormone production. The condition can affect the function of the pituitary gland.


sheehans syndrome pathology, pathophysiology, etiology


Losing a life-threatening amount of blood can decrease the flow of blood to the pituitary gland and for this reason; the body is also deprived from oxygen, resulting to a damage of some organs and vital tissues.

Sheehan’s syndrome can also cause a significant reduction of pituitary hormones. During the period of pregnancy; the pituitary gland will increase or double in size making it susceptible to shock, and the immoderate maternal bleeding might trigger the shock causing certain damage to cells of the gland.

The balance of the hormone production by the pituitary gland might be disturbed giving rise to the clinical features linked with Sheehan’s syndrome.

Symptoms of Sheehan’s Syndrome

Symptoms of Sheehan’s syndrome usually become apparent at a low pace, after a span of months or years although in some cases like in a breast-feeding mother, problems may immediately show up. Symptoms of this condition occur due to the deficiencies of several hormones that the pituitary gland manages, like adrenal, thyroid, menstrual function, and breast milk production.

sheehans syndrome symptoms, clinical features, signs, characterstics

Signs and symptoms may involve:


  • Fatigue
  • Low blood pressure
  • Loss of underarm or pubic hair
  • Difficulty breast-feeding or the incapability to breast-feed
  • Irregular beating of the heart
  • No menstruation periods or if there is, it only occurs infrequently
  • Loss of fascination in sex
  • Weight gain
  • Slowed mental function
  • Difficulty staying warm which results to an underactive throid or hypothyroidism

sheehans syndrome

The disorder can be divided into two types depending on the severity of its damage to the gland’s cells. These are:

Acute form

The extent of damage is considerable and the symptoms occur soon after the delivery of the child.

Chronic form

The amount of damage is lesser and symptoms might not occur for a couple of months or years after the delivery of the child.

Majority of the females have non-specified symptoms of Sheehan’s syndrome and frequently regarded to be caused by other factors. Fatigue for example can be experienced with being a new mother. An individual may be unaware that the condition is there unless a treatment for adrenal or thyroid insufficiency is required.

It is also possible to be asymptomatic with Sheehan’s syndrome depending on the degree of damage to the pituitary gland. A number of women live for several years without knowing that their pituitary gland is not working correctly then all of a sudden, an extreme physical stressor like a surgical procedure or infection prompts an adrenal crisis.

Causes

There are a lot of factors that can lead to low pituitary function, but Sheehan’s syndrome is a result from excessive bleeding during childbirth causing the tissues in the pituitary gland to die.

The pituitary gland is situated at the base of the brain and it stimulates the rest of the endocrine system such as instructing other glands to decrease or increase hormonal production that manage breast milk production, metabolism, blood pressure, fertility, and other vital processes. If any of these hormones is lacking, it could cause certain problems throughout the body though sometimes the symptoms may develop so slowly that they escape notice.

Conditions that can increase the risk of excessive bleeding include problems with the placenta and multiple pregnancies. The placenta is an organ that forms during the pregnancy to feed the fetus.

Diagnosis

Sheehan’s syndrome is not easily diagnosed. Several symptoms overlap with the other conditions. The diagnosis of the condition may involve tests such as:

Complete medical history

The physician will need to know all of the childhood complications of the mother in order to evaluate the key signs of Sheehan’s syndrome.

Blood tests

This is done to measure the pituitary hormone levels.

Pituitary hormone stimulation test

This is to see how much the pituitary gland responds.

Magnetic Resonance Imaging (MRI)

It is an imaging test that can rule out certain pituitary problems in the head, such as a tumor.

Treatment

Treatment for Sheehan’s syndrome involves a lifelong hormone replacement therapy. The dosage and the risks or benefits should be discussed with the physician. One or more of the following medications may be recommended:

Estrogen

It can be used in treating menstrual and menopausal conditions or as oral contraceptives.

Corticosteroids

It could substitute the adrenal hormones that are not being produced due to the adrenocorticotropic hormone (ACTH) deficiency.

Levothyroxine

This can boost the levels of deficient thyroid hormones.

Growth hormone

Some research studies have proved that the replacement of growth hormone in women with Sheehan’s syndrome and those individuals with hypopituitarism could help the body to normalize cholesterol levels, muscle-to-fat ratio, and enhance the overall quality of life.


References

  1. Sheehans syndrome – Complications, Preparing for your appointment, Tests and diagnosis, Treatments and drugs at http://www.drugs.com/mcd/sheehan-s-syndrome
  2. Sheehans syndrome Exams and Tests, Prognosis, Complications at https://www.nlm.nih.gov/medlineplus/ency/article/001175.htm
  3. Sheehans syndrome Related Disorders, Standard Therapies, Investigational Therapies at https://rarediseases.org/rare-diseases/sheehan-syndrome/
  4. Kelestimur F, Jonsson P, Molvalilar S, Gomez JM, Auernhammer CJ, Colak R, Koltowska-Häggström M, Goth MI (2005 Apr). Sheehan’s syndrome: baseline characteristics and effect of 2 years of growth hormone replacement therapy in 91 patients in KIMS – Pfizer International Metabolic Database. Eur J Endocrinol. 152(4):581-7.
  5. Bunch TJ, Dunn WF, Basu A, Gosman RI (October 2002). “Hyponatremia and hypoglycemia in acute Sheehan’s syndrome”. Gynecol. Endocrinol. 16 (5): 419–23.
  6. Schrager S, Sabo L (2001). “Sheehan syndrome: a rare complication of postpartum hemorrhage”. J Am Board Fam Pract 14 (5): 389–91.

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