What are the other Names for this Condition? (Also known as/Synonyms)
- Hypopituitarism Syndrome
- Post-Partum Pituitary Necrosis
- Simmonds’ Syndrome
What is Sheehan Syndrome? (Definition/Background Information)
- Sheehan Syndrome is decreased functioning of pituitary gland, caused by damage to the gland from severe blood loss during or after childbirth. It is a rare complication of pregnancy
- The pituitary gland is a very small gland in the brain, which secretes many essential hormones. When the pituitary gland damage is unrelated to pregnancy, the condition is called Simmonds’ Syndrome
- It is believed by the medical community that 75-90% damage to the anterior pituitary gland is a pre-requisite for Sheehan Syndrome to set in and for the symptoms to show
- Although the exact cause of maternal bleeding is not known, it is believed that the enlarged size of the pituitary gland during pregnancy necessitates increased oxygen demand, and any shortage therefore, predisposes it to damage
- Excessive bleeding and resultant drop in blood pressure damage the pituitary gland. Rarely, damage to the pituitary gland may also be observed with some other conditions such as sickle cell anemia
- The symptoms of Sheehan Syndrome are dictated by the extent of damage to the pituitary gland, and consequent hormonal imbalance. Some typical symptoms include inability to breastfeed the baby, constipation, and reduced mental acuity
- A healthcare provider might use symptoms’ assessment, medical history, along with blood test and/or imaging scans to arrive at an accurate diagnosis
- Standard treatment options for Sheehan Syndrome include hormonal treatment to compensate for loss of pituitary function. The treatment is often required lifelong. If not diagnosed and treated promptly, Sheehan Syndrome could be fatal
- Sheehan Syndrome may be preventable if a healthcare provider is vigilant during childbirth and proper medical care for excessive bleeding is rendered. With an early diagnosis and prompt treatment, the prognosis for the condition is reported to be excellent
Who gets Sheehan Syndrome? (Age and Sex Distribution)
- Sheehan Syndrome is predominantly seen in women who bleed excessively during childbirth (excessive blood loss during delivery)
- Pregnant females may get the condition, though it is very rare during this period
- The exact incidence rate across populations is not known, but it is a rare condition
What are the Risk Factors for Sheehan Syndrome? (Predisposing Factors)
Some known risk factors for Sheehan Syndrome include the following:
- A woman delivering babies following multiple pregnancies (such as twins and triplets)
- Any abnormality associated with the placenta
- Pituitary necrosis, the underlying cause of the syndrome, could also develop in cases, such as sickle cell anemia, giant cell arteritis, and trauma to the head
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Sheehan Syndrome? (Etiology)
The exact cause of Sheehan Syndrome is not known.
- However, one theory is that, as the pituitary gland enlarges in size during pregnancy, it is more prone to damage
- The severe drop in blood pressure that occurs during blood loss in delivery may reduce the blood supply to the brain, leading to insufficient oxygen to accommodate for the enlarged gland. This results in cell death in the pituitary gland (called pituitary necrosis)
Pituitary necrosis leads to reduced production of several hormones, such as:
- Prolactin, which is needed for breast milk production
- Adrenocorticotropic hormone, which is needed for stimulation of the adrenal glands (cortisol production)
- Growth hormone, which is needed for bone, tissue, and muscle growth
- Follicle-stimulating hormone, which is needed for development of egg and ovulation
- Luteinizing hormone, which is needed for estrogen production and balance
- Thyroid stimulating hormone, which is needed for thyroid hormone production and metabolism
- Antidiuretic hormone, which is needed for urine production and water balance
The resultant hormonal imbalance leads to several symptoms commonly observed in patients with Sheehan Syndrome.
What are the Signs and Symptoms of Sheehan Syndrome?
- The signs and symptoms of Sheehan Syndrome are those caused by deficiencies of the various hormones the pituitary gland controls. The glands and functions affected include the thyroid gland, adrenal gland, breast milk production, and menstrual function
- The patient may not be able to breastfeed, due to inhibition of the hormones that results from damaged posterior pituitary gland
Other symptoms observed with Sheehan Syndrome include:
- Lack of menstrual bleeding or decreased menstrual bleeding
- Lack of pubic or underarm hair
- Low blood pressure
- Weight loss or weight gain
- Constipation and slowness of mental function
How is Sheehan Syndrome Diagnosed?
A healthcare provider may diagnose Sheehan Syndrome using the following tools:
- A clinical history of significant blood loss during child birth
- Symptoms, such as an inability to breastfeed after delivery or difficulty with the same and menstrual disturbances after delivery
- Various blood tests to check hormonal levels
- MRI or CT scans to identify any damage to the pituitary gland
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the Complications of Sheehan Syndrome?
If it is not diagnosed and treated promptly, Sheehan Syndrome could be a fatal condition.
How is Sheehan Syndrome Treated?
- Sheehan Syndrome condition may require lifelong hormone replacements, as determined by blood tests
- An endocrinologist will need to be consulted to periodically monitor hormonal levels and manage accordingly
How can Sheehan Syndrome be Prevented?
Identifying acute or severe blood loss during and immediately after childbirth and taking immediate, appropriate steps to correct it, may help prevent Sheehan Syndrome.
What is the Prognosis of Sheehan Syndrome? (Outcomes/Resolutions)
The prognosis for Sheehan Syndrome is reported to be excellent, if there is an early diagnosis, with appropriate management and regular follow-up.
Additional and Relevant Useful Information for Sheehan Syndrome:
The US National Organization for Rare Disorders categorizes Sheehan Syndrome as a “rare disorder”.