About Sheehan's Syndrome

Sheehan's syndrome is a condition that arises when a woman suffers critical blood loss during childbirth. The severe oxygen deprivation in this situation can cause damage to organs, and in Sheehan's syndrome, most affected is the pituitary gland.

What are the causes?

When a great deal of blood is lost during childbirth, the pituitary gland is unable to produce enough hormone for the gland to function as it should. Also, if hemorrhage occurs, the blood pressure drops abnormally low, which further damages the pituitary gland.

A decrease in pituitary gland function also affects the rest of the endocrine system, causing other organs less ability to function normally. This affects healing, metabolism, thyroid function, normal growth, and other body processes.

Who is at risk?

Although Sheehan's syndrome is rare, particularly in developed countries, most at risk for the condition are women pregnant with multiples, or with placenta abnormalities.

What are the symptoms?

Sheehan's syndrome, because it is so rare, and symptoms can appear so gradually, is often misdiagnosed or undiagnosed for long periods of time. In nursing mothers it may be detected earlier since the lactating hormones can be affected.

Other symptoms include loss of hair in underarm and pubic areas, low blood pressure, cessation of or more infrequent menstruation, abnormal weight loss or weight gain, extreme fatigue, and mental confusion or feeling "slow" mentally. Since so many of these symptoms can be attributed to other things, many times the condition is undiagnosed until there is an adrenal or thyroid crisis. Stresses such as having surgery or getting an infection can trigger such a crisis, at which time the Sheehan's syndrome can become evident.

What tests are done for Sheehan's syndrome?

Careful reportage of symptoms is important in the diagnosis of Sheehan's syndrome. Further workup includes blood tests for pituitary hormone levels and imaging by MRI and/or CT scan to determine pituitary gland size or possible tumor to rule out other reasons for pituitary dysfunction.

What are possible complications?

Besides the symptoms named, a serious life-threatening situation can occur in Sheehan's syndrome patients. Adrenal crisis may occur, in which an illness or surgery can stress the adrenal glands into producing too low a quantity of a stress hormone called cortisol. This throws the body into shock, low blood pressure, and possibly coma leading to death. For this reason, once Sheehan's syndrome is diagnosed, a medical alert bracelet will often be given to the patient to wear at all times.

How is it treated?

Hormone replacement therapy is the main treatment for Sheehan's syndrome. Growth hormone, estrogen and thyroid boosters will be given. Also corticosteroids are usually prescribed, to replace adrenal hormones when they are too low. Blood tests are performed often to achieve the right balance of hormones in the patient.

Prognosis is good for Sheehan's syndrome patients once the condition has been diagnosed and treatment commences. It's important to keep the endocrinologist informed of any changes in circumstances such as pregnancy, illness or necessary surgery to make any appropriate adjustments in treatment.

Sources:

Signet/Mosby Medical Encyclopedia

Mayo Clinic

National Institute of Health