SHEEHAN SYNDROME

Introduc4on

• Sheehan syndrome is characterized by the loss of pituitary • Prevalence: Rare; less than 1 of 10,000 deliveries.
func7on, resul7ng from damage or necrosis that occurs through • Predominant Age: Reproduc7ve age.
anoxia, thrombosis, or hemorrhage. • Gene7cs: No gene7c paHern.
• When associated with pregnancy, it is called Sheehan syndrome;
when unrelated to pregnancy, it is called Simmonds disease.

E4ology And Pathogenesis

• Causes: Anoxia, thrombosis, or hemorrhage that results in • Rarely follows snake bite (Russell viper).
damage or necrosis of the pituitary gland. • Risk Factors: Postpartum hemorrhage with hypotension.
• The exact mechanism of pituitary damage is unknown, and
pituitary damage can rarely occur even in the absence of
hemorrhage.

Signs And Symptoms

• Secondary amenorrhea • Postpartum failure of lacta7on and loss of pubic and axillary hair
• Secondary hypothyroidism (lacta7on following delivery virtually precludes pituitary
• Adrenal insufficiency (the degree of pituitary damage and necrosis)
resultant loss is highly variable; as a result the reduc7on of • Uterine superinvolu7on
adrenal and thyroid hormone produc7on seen is also variable,
from slight to virtually complete loss)
Diagnos4c Approach

Differen'al Diagnosis Workup and Evalua'on

• Lacta7onal amenorrhea • Laboratory: Follicle-s7mula7ng hormone (FSH), luteinizing
• Pregnancy hormone (LH), thyroid-s7mula7ng hormone (TSH), and
• Exogenous hormone use adrenocor7cotropin hormone (ACTH) levels are diagnos7c.
• Metabolically ac7ve ovarian tumor • Imaging: Computed tomography (CT) or magne7c resonance
• Other causes of secondary amenorrhea imaging (MRI) of the pituitary is sugges7ve but not diagnos7c.
• Associated Condi7ons: Hypothyroidism, adrenal insufficiency,
and postpartum hemorrhage Pathologic Findings
Necrosis of the pituitary gland.

Management And Therapy

Nonpharmacologic Drug(s) of Choice

• General Measures: Evalua7on (rapid; poten7ally life-threatening Hormone replacement (thyroid, adrenal, and ovarian steroids).
through loss of adrenal and thyroid hormones).
• Specific Measures: Hormone replacement (thyroid, adrenal, and
ovarian steroids).
• Diet: No specific dietary changes indicated.
• Ac7vity: No restric7on.
• Pa7ent Educa7on: Pa7ents must be carefully instructed when
con7nua7on of adrenal and thyroid hormone replacement
therapy is required.

Follow-Up

• Pa7ent Monitoring: Careful follow-up of thyroid and adrenal • Expected Outcome: With 7mely diagnosis and hormone
func7ons is required. replacement, normal life and func7on may be expected.
• Preven7on/Avoidance: Maintenance of adequate perfusion and
oxygena7on when postpartum hemorrhage occurs.
• Possible Complica7ons: Failure to diagnose the loss of pituitary
func7on can result in life-threatening adrenal insufficiency and
hypothyroidism.