Sheehan’s Syndrome

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Sheehan’s syndrome, or postpartum pituitary infarction (postpartum pituitary necrosis), is a neuroendocrine disorder that is caused by the death of pituitary cells due to difficult labor or abortion. This situation is provoked by massive blood loss during childbirth or abortion. Symptoms of the disease develop gradually, associated with insufficient production of various pituitary hormones.  Read More

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Sheehan’s Syndrome

What is Sheehan’s Syndrome?

Sheehan’s syndrome, or postpartum pituitary infarction (postpartum pituitary necrosis), is a neuroendocrine disorder that is caused by the death of pituitary cells due to difficult labor or abortion. This situation is provoked by massive blood loss during childbirth or abortion. Symptoms of the disease develop gradually, associated with insufficient production of various pituitary hormones. 

Sheehan’s Syndrome
Picture Courtesy: med doses

What is the classification of Sheehan’s syndrome?

Sheehan’s syndrome is classified based on the forms and stages of development of the disease. 

The stages include:

  • Early-stage:- Frequent headaches, edema, menstrual irregularities, and hypotension are common
  • Middle-stage:- Causes hypothyroidism (persistent lack of thyroid hormones), weight loss, and a sharp decrease in blood pressure.
  • Later-stage:- There are problems with sexual activity, anemia, and severe weakness -up to the inability to move, weight decreases sharply, and hair falls.

The forms of Sheehan’s syndrome are as follows: 

  • Global form:- There is a deficiency of thyroid-stimulating hormone (TSH) and adrenocorticotropic hormone (ACTH).
  • Partial form:- In this case, there is a deficiency in the functioning of adrenocorticotropic, thyrotropic, and gonadotropic cells.
  • Mixed form:- Deficiency of several functions at the same time, for example, lack of the adrenocorticotropic hormone and low thyrotropin.

Causes

Sheehan’s syndrome is caused by pituitary gland failure during or after childbirth. During pregnancy, the pituitary gland increases in size, which means it requires more active blood flow. Lack of blood supply and massive blood loss can cause pituitary gland failure.

The pituitary gland is a part of the central nervous system located inside the skull in the sella turcica. It controls the functioning of most of the endocrine glands of the body, releasing several hormones, and regulates the female reproductive system.

The reasons that lead to pituitary gland failure, ultimately causing Sheehan’s syndrome include:

  • Severe bleeding: severe blood loss during or after childbirth, excessive bleeding during an ectopic pregnancy, uterine hypotension, Uterine rupture, and Placental abruption
  • DIC syndrome: caused by hemorrhagic diathesis with increased blood coagulation inside the vessels, which leads to the formation of blood clots. DIC syndrome appears due to massive bleeding.
  • Gestosis: a pregnancy complication that causes high blood pressure, proteinuria, and edema. It also affects the vital organs and systems of the body. It can happen due to multiple pregnancies and no recommended gaps between the two pregnancies.

In addition to the above reasons, there is one more provoking factor for Sheehan’s syndrome. Factor include: 

  • Toxicosis in late pregnancy is a dangerous complication during childbearing. Late toxicosis can cause acute heart failure, pulmonary edema, coma, premature placental abruption, and acute hypoxia (oxygen starvation) of the fetus.

Symptoms

symptoms of Sheehan’s syndrome
Picture Courtesy: verywellhealth

The risk of developing Sheehan’s syndrome depends on the amount of blood loss: the more blood is lost, the higher the risk of pituitary gland failure.

Symptoms of Sheehan’s syndrome are often associated with the work of certain glands like:

  • Reproductive gland (gonad)
  • Thyroid
  • Adrenal glands

The main symptoms in case of damage to the glands that are responsible for the production of sex steroids include: 

  • Low milk supply (lactation insufficiency) after childbirth
  • Gradual weight loss (up to 6 kg per month)
  • Amenorrhea (absence of menstruation)
  • Atrophy of the mammary glands
  • Very little or no regrowth of shaven pubic and armpits hair
  • Decrease or complete lack of sex drive

If the thyroid gland is affected, then the following symptoms are observed:

  • Constant drowsiness
  • Lethargy
  • Low body temperature
  • Constipation
  • Atony (lack of normal tone of internal organs and skeletal muscles) of the digestive tract

Sheehan’s syndrome also causes the following specific symptoms: 

How is Sheehan’s syndrome diagnosed?

Sheehan's syndrome diagnosis
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Symptoms of neuroendocrine dysfunction after recent complicated childbirth or abortion require a thorough study of pituitary gland functions.

Diagnosis of Sheehan’s syndrome aims to assess the functioning of the pituitary tissue and the patient’s general condition. The most informative methods for diagnosing postpartum hypopituitarism are:

  1. Study of the levels of various hormones in the body. Week secretion of the adenohypophysis is due to a low level of prolactin and hormones like:
  • Luteinizing (LH)
  • Adrenocorticotropic (ACTH)
  • Thyroid-stimulating (TSH)
  • Follicle-stimulating (FSH)

2. Medical Imaging Techniques- to see a decrease in the pituitary gland size. The patient may also ask to take a targeted X-ray sella turcica. For detailed information on the changes and structure of the gland, the doctor performs the following diagnosis method:

What is the differential diagnosis of Sheehan’s syndrome?

Certain conditions show symptoms similar to Sheehan’s syndrome, so generating a differential diagnosis helps to confirm the disease. 

  • Primary Adrenal Insufficiency:- Disease shows signs like pigmentation, hair loss, and low concentration of ACTH.
  • Anorexia nervosa:- Absence of menstruation (Amenorrhea) is a common symptom of Sheehan’s syndrome and Anorexia Nervosa.

Primary hypothyroidism:- Shows signs such as fatigue, constipation, dry skin, and muscle weakness.

How is Sheehan’s syndrome treated?

The main goal of the treatment of Sheehan’s syndrome is to maintain hormone levels and relieve symptoms. The treatment course depends on the form and severity of the disease. With minor damage to the organ, after a proper treatment regimen, it is possible to achieve recovery and a complete cure.

The regimen includes the use of specific methods and approaches like:

  • Glucocorticosteroids:- Prednisolone and hydrocortisone are the most often prescribed drugs with a minimum effective dose of 5 mg. This drug has several side effects; as a preventive measure, a doctor may recommend that the patient simultaneously take calcium, potassium, and H2 blockers to prevent atrophic gastritis. The patient is advised to take medication for a longer duration. In a few cases, it is recommended to take it for the rest of their lives. 
  • Hormone replacement therapy (HRT):- When treating Sheehan’s syndrome with HRT, hormonal agents are prescribed, which include both estrogen and progesterone. Oral contraceptives are recommended for women with the irregular menstrual cycle.
  • Estrogen and progesterone: – 
  • Thyroid hormones:- L-thyroxine is prescribed to treat hypothyroidism. Initially, a minimum dose is used, and gradually the dose is increased until a therapeutic effect is achieved.

Additionally, combinations of vitamins and minerals help to strengthen the immune system. With pronounced weight loss, the patient may require to use drugs that boost metabolism and provide the body with a sufficient amount of energy. Depending on the course of the disease, the doctor may prescribe medications to improve cardiac activity and prevent gastrointestinal problems and other complications.

Diet during the treatment regimen

While taking medicines, it is necessary to maintain a balanced diet. The patient may ask to eat cereals (buckwheat, barley, wheat), skim milk, raw almonds, spinach, beans, bananas, baked potatoes, dark chocolate (in small quantities), etc. During treatment, the entire diet plan should be prepared by a nutritionist.

FAQ

What are the risk factors for Sheehan’s syndrome?

Obstetricians-gynecologists predict the following risk factors for the development of Sheehan’s syndrome:
1)       Blood clotting disorders in pregnant women (in particular, low platelet levels)
2)       Peripheral edema
3)       Gestational hypertension (high blood pressure)
4)       Pre-eclampsia, high blood pressure, and proteinuria
5)       Increased hemolysis (the breakdown of RBC)
6)       Placenta previa
7)       Multiple pregnancies (twins or triplets)

How can Sheehan’s syndrome be prevented?

1)       The primary prevention for this disease is to monitor and manage the entire pregnancy carefully, especially for women with severe gestosis. 
2)       Specialists should carefully carry out the complete birth process, preventing possible bleeding.
3)       Performing an abortion with no exception, and as for the woman herself, it is advisable to plan pregnancy.
4)       It is necessary to register on time with the antenatal clinic and regularly undergo examinations by an obstetrician-gynecologist.

What are the common complications of Sheehan’s syndrome?

If the condition is severe, there is a high probability of complications. Persistent hormonal deficiency provokes dangerous changes in the female body:
1)       Dysfunction of the heart and vascular system
2)       Adrenal insufficiency
3)       hypochromic anemia
4)       hypoglycemia (low blood sugar)
5)       irregular menstrual cycle
6)       low blood pressure
7)       unusual weight gain or loss
8)       low sex drive
9)       difficulty in attaining pregnancy and breastfeeding [2].

How rare is Sheehan’s syndrome?

According to research, Sheehan’s syndrome is a rare condition in developed nations compared with developing ones. It probably occurs in five out of 100,000 women giving birth each year.

Is Sheehan’s syndrome contagious?

No. Sheehan’s syndrome is not like a seasonal viral or bacterial infection. It cannot be transmitted from person to person.

What is the prognosis (outcome) of Sheehan’s syndrome?

Sheehan’s syndrome can be a life-threatening condition if left untreated or if there is a delay in diagnosis or treatment. People on long-term hormone therapy will be able to live everyday healthy lives [1].

Can hormone imbalance due to Sheehan’s syndrome cause neurological problems?

Yes, in the case of Sheehan’s syndrome, a drastic fall in essential hormones that play a vital role in organ functioning can cause memory loss and dementia.

References

  1. https://www.healthline.com/health/sheehan-syndrome#outlook
  2. https://healthlibrary.askapollo.com/sheehans-syndrome-symptoms-treatment-and-causes/