Sheehan’s Syndrome

Published on 06/06/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 06/06/2015

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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
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