What is Sheehan’s syndrome (Postpartum hypopituitarism, Postpartum pituitary insufficiency)

Sheehan’s syndrome is a condition that may occur in a woman who has a severe uterine hemorrhage during childbirth. The resulting severe blood loss causes tissue death in her pituitary gland and leads to hypopituitarism following the birth.

Statistics on Sheehan’s syndrome (Postpartum hypopituitarism, Postpartum pituitary insufficiency)

Sheehan’s syndrome is very rare now because of wide access to good obstetrical care. I
Incidence is 1/10,000 deliveries.

Risk Factors for Sheehan’s syndrome (Postpartum hypopituitarism, Postpartum pituitary insufficiency)

Conditions that increase the risk of an obstetric hemorrhage and thus of Sheehan’s syndrome include multiple pregnancies (twins or triplets) and abnormalities of the placenta.

Progression of Sheehan’s syndrome (Postpartum hypopituitarism, Postpartum pituitary insufficiency)

If a woman’s pituitary gland is starved of blood because she bled severely during childbirth, the gland may lose its ability to function properly. The pituitary gland, which is located at the base of the brain, is responsible for producing a variety of hormones that help regulate growth, reproduction, and metabolism. The pituitary gland normally produces hormones that stimulate breast milk production, growth, reproductive functions, the thyroid, and the adrenal glands. A lack of these hormones results in a variety of symptoms related to all of these areas.
Hypopituitarism resulting from an infarct of the pituitary following postpartum shock or haemorrhage. Damage to the anterior pituitary gland causes partial or complete loss of thyroid, adrenocortical, and gonadal function.
The complete concept of the syndrome was well reviewed by Sheehan in 1937. He emphasised that during pregnancy the pituitary becomes enlarged, but its blood supply becomes diminished during childbirth and it is particularly susceptible to thrombosis. Reports indicate that the syndrome occurs more frequently than is usually recognised.

How is Sheehan’s syndrome (Postpartum hypopituitarism, Postpartum pituitary insufficiency) Diagnosed?

Upon a general investigation symptoms may include: an inability to breast-feed (breast milk never “comes in”), Fatigue, Loss of pubic and axillary hair, amenorrhea, or lack of menstrual bleeding and low blood pressure.

Prognosis of Sheehan’s syndrome (Postpartum hypopituitarism, Postpartum pituitary insufficiency)

The outlook with early diagnosis and treatment is excellent.

How is Sheehan’s syndrome (Postpartum hypopituitarism, Postpartum pituitary insufficiency) Treated?

The treatment for pituitary insufficiency is lifelong hormone substitute medication, including estrogen and progesterone hormone replacement. Thyroid and adrenal hormones also must be taken.

Sheehan’s syndrome (Postpartum hypopituitarism, Postpartum pituitary insufficiency) References

[1] H. L. Sheehan: Post-partum necrosis of anterior pituitary. The Journal of Pathology and Bacteriology, Chichester, 1937, 45: 189-214.
[2] Kumar, P. Clark, M. CLinical Medicine 5th Ed. 2002 WB Saunders.
[3] Muse, Ken. Sheehan’s Syndrome, 2000.
[4] Rein, Daniel. University of Alabama, Birmingham, AL.