Sheehan’s Syndrome

Published on 06/06/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 22/04/2025

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Chapter 175 Sheehan’s Syndrome

INTRODUCTION

Description: Sheehan’s syndrome is characterized by loss of pituitary function resulting from damage or necrosis that occurs through anoxia, thrombosis, or hemorrhage. When associated with pregnancy, it is called Sheehan’s syndrome; when unrelated to pregnancy it is called Simmonds disease.
Prevalence: Rare, less than 1 of 10,000 deliveries.
Predominant Age: Reproductive.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Anoxia, thrombosis, or hemorrhage that results in damage or necrosis of the pituitary gland. (The exact mechanism of pituitary damage is unknown.)
Risk Factors: Postpartum hemorrhage with hypotension.

CLINICAL CHARACTERISTICS

Signs and Symptoms

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

DIAGNOSTIC APPROACH

Differential Diagnosis

• Lactational amenorrhea
• Pregnancy
• Exogenous hormone use
• Metabolically active ovarian tumor
• Other causes of secondary amenorrhea

Associated Conditions: Hypothyroidism, adrenal insufficiency, and postpartum hemorrhage.

Workup and Evaluation

Laboratory: Follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), and adrenocorticotropin hormone (ACTH) levels are diagnostic.
Imaging: Computed tomography (CT) of the pituitary is suggestive but not diagnostic.
Special Tests: None indicated.
Diagnostic Procedures: History and laboratory evaluation.

Pathologic Findings

Necrosis of the pituitary gland.

MANAGEMENT AND THERAPY

Nonpharmacologic

General Measures: Evaluation (rapid, potentially life threatening through loss of adrenal and thyroid hormones).
Specific Measures: Hormone replacement (thyroid, adrenal, and ovarian steroids).
Diet: No specific dietary changes indicated.
Activity: No restriction.
Patient Education: Patients must be carefully instructed in the need for continuing adrenal and thyroid hormone replacement therapy.

Drug(s) of Choice

Hormone replacement (thyroid, adrenal, and ovarian steroids).

FOLLOW-UP

Patient Monitoring: Careful follow-up of thyroid and adrenal function is required.
Prevention/Avoidance: Maintenance of adequate perfusion and oxygenation when postpartum hemorrhage occurs.
Possible Complications: Failure to diagnose the loss of pituitary function can result in life-threatening adrenal insufficiency and hypothyroidism.
Expected Outcome: With timely diagnosis and hormone replacement, normal life and function may be expected.

MISCELLANEOUS

Pregnancy Considerations: Without ovulation induction and assisted reproduction, pregnancy is unlikely.
ICD-9-CM Codes: 253.2.

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REFERENCES

Level III

Benvenga S, Campenni A, Ruggeri RM, Trimarchi F. Clinical review 113: hypopituitarism secondary to head trauma. J Clin Endocrinol Metab. 2000;85:1353.

Cunningham FG, Gant NF, Leveno KJ, et al, editors Williams obstetrics 21st ed. 2001 McGraw-Hill New York 638

Grimes HG, Brooks MH. Pregnancy in Sheehan’s syndrome. Report of a case and review. Obstet Gynecol Surv. 1980;35:481.

Lamberts SW, de Herder WW, van der Lely AJ. Pituitary insufficiency. Lancet. 1998;352:127.

Miller KK, Biller BM, Hier J, et al. Androgens and bone density in women with hypopituitarism. J Clin Endocrinol Metab. 2002;87:2770.

Roberts DM. Sheehan’s syndrome. Am Fam Physician. 1988;37:223.

Schneider HJ, Aimaretti G, Kreitschmann-Andermahr I, et al. Hypopituitarism. Lancet. 2007;369:1461.

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