Sheehan syndrome
Postpartum hypopituitarism; Postpartum pituitary insufficiency; Hypopituitarism syndrome; Sheehan's syndrome
Sheehan syndrome is a condition that can occur in a woman who bleeds severely during childbirth. Sheehan syndrome is a type of hypopituitarism.
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
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.
Version Info
Last reviewed on: 11/10/2022
Reviewed by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
