SHEEHAN SYNDROME

Sheehan's syndrome (SS) is postpartum hypopituitarism caused by necrosis of the pituitary gland. Sheehan's syndrome, though rare, is still one of the commonest causes of hypopituitarism in developing countries like ours. The clinical presentation is variable with abrupt or insidiously developing pituitary insufficiency after a heavy intra-partum or postpartum haemorrhage. It is usually the result of severe hypotension or shock caused by massive haemorrhage during or after delivery. Patients with SS have varying degrees of anterior pituitary hormone deficiency. Its frequency is decreasing worldwide and it is a rare cause of hypopituitarism in developed countries owing to advances in obstetric care. However, it is still frequent in underdeveloped and developing countries. SS often evolves slowly and hence is diagnosed late. History of postpartum haemorrhage, failure to lactate and cessation of menses are important clues to the diagnosis. Basal hormone levels may be enough in patients with typical histories, but most of the patients need more detailed investigation including dynamic pituitary function tests. The presence of anti-pituitary antibodies (APAs) has been demonstrated in some patients with SS, suggesting that an autoimmune pituitary process could be involved in this syndrome. Pituitary MRI and CT may also be helpful for the investigation. Treatment of SS includes replacement of deficient hormone and the early diagnosis and appropriate treatment are important to reduce morbidity and mortality of the patients.

Neuro endocrinology letters, 2005

Sheehan syndrome (SS) or post-partum pituitary necrosis is a pituitary insufficiency secondary to excessive post-partum blood losses. SS is a very significant cause of maternal morbidity and mortality in developing countries although it is a rarity in developed countries in which obstetrical care has been improved. In this study, we reviewed 20 cases retrospectively who were diagnosed as SS in our clinic. The patients aged 40 to 65 years with a mean age of 51.12 +/- 9.44 years (mean +/- SD). Time to make a definitive diagnosis of the disease ranged between 5 and 25 years with a mean of 16.35 +/- 4.74 years. Three of our patient (15%) had a previous diagnosis of SS. Three patients (15%) were referred to emergency service for hypoglycemia, three patients (15%) for hypothyroidism and one patient (5%) for hyponatremia. Dynamic examination of the pituitary revealed GH, Prolactin, FSH, TSH and ACTH insufficiency in all of the patients. One of our patients had a sufficient LH response to L...

2000

Sheehan syndrome; pituitary insuffi ciency; empty sella Abstract Sheehan syndrome (SS) or post-partum pituitary necrosis is a pituitary insuffi - ciency secondary to excessive post-partum blood losses. SS is a very signifi cant cause of maternal morbidity and mortality in developing countries although it is a rarity in developed countries in which obstetrical care has been improved. In this study,

European journal of endocrinology / European Federation of Endocrine Societies, 2014

Sheehan's syndrome (SS) is a well-known cause of hypopituitarism resulting from postpartum pituitary necrosis. Because of its rarity in Western society, its diagnosis is often overlooked. We aimed to investigate the clinical, laboratory, and radiological aspects of SS in a large number of patients. A retrospective assessment of the medical records of 114 patients with SS was conducted. In addition, sella turcica volumes of 29 healthy women were compared with those of patients by magnetic resonance imaging examinations. The mean period of diagnostic delay was 19.7 years in patients with SS. It was found that 52.6% of patients had nonspecific complaints, 30.7% had complaints related to adrenal insufficiency, and 9.6% had complaints related to hypogonadism when diagnosed. At the time of diagnosis, 55.3% of the patients had panhypopituitarism, while 44.7% had partial hypopituitarism. The number of deficient hormones was found to be increased over the years. None of the patients whos...

Journal of Medical Science And clinical Research, 2019

Sheehans Syndrome (SS) is postpartum hypopituitarism caused by ischemic necrosis of the pituitary gland. Usually it results from severe hypotension or shock caused by massive haemorrhage during or after delivery. Enlargement of pituitary gland, small sellar size, DIC and autoimmunity are considered as other causal factors. Its incidence is currently decreasing in developed countries owing to improved obstretic care. We are here by presenting a case report of 53 year old female who had history of PPH during her second pregnancy, presented to casuality with complaints of fever, vomiting, loose stools and shortness of breath. On evaluation she was diagnosed as SCRUB typhus and found to have pancytopenia which did not improve with the treatment of underlying infection. In due course patient developed hyponatremia. On subsequent evaluation she was diagnosed to have hypocortisolism and hypothyroidism. MRI Pituitary was suggestive of SHEEHANS SYNDROME. In view of non specific presentation and little importance paid to the menstrual history there was a delay in the diagnosis and treatment.

The Journal of the Association of Physicians of India, 2016

Sheehan's syndrome, though rare, is still one of the commonest causes of hypopituitarism in developing countries like ours. The clinical presentation is variable with abrupt or insidiously developing pituitary insufficiency after a heavy intrapartum or postpartum haemorrhage. We present an elderly lady with this syndrome who had slowly progressive panhypopituitarism 24 years after a severe haemorrhage associated with the delivery of triplets.

Case Reports in Clinical Medicine, 2013

Sheehan's Syndrome (SS) occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. We report a 41-year-old woman with a history of severe postpartum hemorrhage 18 years prior to presentation. During this period of time, she experienced severe fatigue. Three months prior to being admitted to our hospital, the patient started to notice alopecia, generalized edema and cognitive impairment. After proper investigation, laboratory tests and clinical findings indicated panhypopituitarism. In addition to neuroimaging and past medical history, SS was diagnosed and treatment started. We emphasize the importance of thorough investigation, further diagnosis and management of this condition (especially in third world countries), since SS is a neurological and endocrinological emergency and potentially life threatening.

Cureus, 2019

Sheehan's syndrome is hypopituitarism due to pituitary gland necrosis resulting from hemorrhagic shock during pregnancy. It is a rare complication with varied manifestations and a considerable delay in diagnosis. We describe the case of a 36-year-old female with eight years of non-specific symptoms of generalized myalgias and intense fatigue managed symptomatically all these years. Further clinical assessment revealed amenorrhea and agalactia ongoing for several years without a clinical diagnosis. A good history and physical led to the diagnosis during a routine outpatient visit. She had significant improvement noted following the commencement of treatment. Previous case reports describe cases being diagnosed after one or other complications from long-term panhypopituitarism. Through this case, we want to illustrate that undiagnosed Sheehan's syndrome is associated with long-term morbidity, and there should be a high index of suspicion for it to be diagnosed during a routine clinical visit and thus prevent complications before a diagnosis can be made. It is essential to create awareness, especially in developed countries like the United States, where it has received less attention over the last few years.

International Journal of Research in Medical Sciences, 2020

Sheehan’s syndrome is the name given to postpartum hypopituitarism, usually precipitated by massive uterine haemorrhage and hypovolemic shock during or after childbirth resulting into pituitary injury in varying degrees. Most cases are diagnosed very late in life and the first presentation may be a life-threatening situation like shock or cardiorespiratory collape. This hidden nemesis in women compromises their quality of life and may result into mortality if not suspected early. In this article we present 3 patients who presented in the ICU in a state of complete cardio-respiratory collapse and later discharged in full health.

Marshall Journal of Medicine, 2017

Sheehan's syndrome typically occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage and can present with varying degrees of pituitary insufficiency. It is more common in underdeveloped countries, and is frequently diagnosed years after delivery due to its nonspecific signs and symptoms. Failure to lactate is a common initial symptom, while many women also report amenorrhea or oligomenorrhea. This article presents a 26-year-old female with a history of hypertension who presented to the hospital for diarrhea, vomiting, and dizziness. Her blood pressure was 80/40 mmHg, requiring aggressive fluid resuscitation, after which it remained borderline. Further testing resulted in an ACTH stimulation test with inadequate response, secondary hypothyroidism, and low prolactin. Her menstrual period could not be assessed due to daily progesterone therapy for contraception. MRI of the brain showed an empty sella, after which she was diagnosed with Sheehan's syndrome, and started on hydrocortisone and levothyroxine.