Sheehan syndrome
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Sheehan syndrome also know as postpartum hypopituitarism, postpartum panhypopituitarism, postpartum panhypopituitary syndrome, postpartum pituitary necrosis and simmond’s disease is the condition of pituitary insufficiency (hypopituitarism) may occur in a women who have postpartum hemorrhage ( excessive bleeding during childbirth). Generally 800ml or more blood lost is needed to developed sheehan syndrome.
What is the pathophysiology of Sheehan syndrome?
Pituitary gland enlarges(hypertrophy and hyperplasia) during pregnancy .When postpartum hemorrhage occurs excessive blood is lost and drop in blood pressure( hypotension) results is pituitary necrosis due to decreased blood supply to the pituitary gland .
Anterior pituitary hormones includes growth hormone, thyroid stimulation hormone, luteinizing hormone, follicle stimulation hormone , adrenocorticotropic hormone and prolacting are decreased due to pituitary necrosis which is the characteristics of sheehan syndrome.
What are the symptoms and signs of sheehan syndrome?
Symptoms and signs of this syndrome appear after a of months or even years .
Symptoms and signs includes :
- Absent of breast feeding or difficult with breast feeding
- Amenorrhea or oligomenorrhea after delivery , decreased libido
- Weight gain , intolerance of cold ,slowed mental function, constipation
- Loss of pubic hair ,underarm hair and ever eyebrow.
- Hypotension
- Weight loss, fatigue, hypoglycemia
- Hyponatremia
- Some patients present with coma
What is the complication of the sheehan syndrome?
Addisonian crises is the most life threatening complication of the sheehan syndrome .
How is sheehan syndrome diagnosed ?
Diagnosis relies on clinical finding, laboratory test and radiological imaging.
Laboratory tests shows ;
- Decreased levels of TSH, ACTH, FSH, LH , GH and prolacting
- Decreased levels of T3, T4, cortisol and estradiol in the blood
Imaging includes CT and MRI shows the size of pituitary gland (usually patients has empty sella) and also help to exclude other conditions.
How to managed sheehan syndrome?
Lifelong hormone replacement therapy is needed , which includes;
- Corticosteroid such as hydrocortisone , prednisone is the first hormone that need to be replaced to prevent Addisonian crises .
- Levothyroxin( only used after corticosteroid ) increases the thyroid hormone level .
- Estrogen and progesterone
- Growth hormone replacement
- Fluid and electrolyte in hypotensive patients.
What is the prognosis of sheehan syndrome?
With early diagnosis and treatment prognosis is excellent
References:
- http://www.mayoclinic.com
- http://www.nlm.nih.gov
- http://en.wikipedia.org
- http://www.ncbi.nlm.nih.gov
- http://www.cigna.com
- Harrison’s Principles of Internal Medicine, 17th edition.
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