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Sheehan’s Syndrome

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Sheehan’s Syndrome

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 labour 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.  Classification […]

Symptoms

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: 

  • Low blood pressure (in the case of adrenal gland damage)
  • Low blood sugar
  • Uneven heartbeat
  • Loss of hair, teeth
  • Hyperpigmentation
  • Dry skin

Causes

Sheehan's syndrome is caused by pituitary gland failure during or after childbirth. During pregnancy, the pituitary gland increases in size, which means that 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: is 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, acute hypoxia (oxygen starvation) of the fetus.

Sheehan's syndrome diagnosis

Symptoms of neuroendocrine dysfunction after recent complicated childbirth or abortion require a thorough study of pituitary gland functions.

Diagnosis of Sheehan's syndrome aimed at assessing the functioning of the pituitary tissue and the general condition of the patient. 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)
  1. Medical Imaging Techniques- to see a decrease in the size of the pituitary gland. You 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:
    • Magnetic resonance imaging (MRI), especially of the head
    • Computed tomography (CT)
    • Ultrasound tomography (UST) of pelvic organs, thyroid gland, kidneys, and adrenal glands
    • Optical tomography (OT)
    • Clinical analysis of urine and blood

Sheehan's syndrome differential diagnosis

Certain conditions show symptoms similar to Sheehan's syndrome, so generating 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.

Treatment for Sheehan's syndrome

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 complete cure.

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

  • Glucocorticosteroids:- Prednisolone is most often prescribed with a minimum effective dose of 5 mg. The drug has several side effects; as a preventive measure, a doctor may recommend you to simultaneously take calcium, potassium, and H2 blockers to prevent atrophic gastritis. The medication is for a long time, but sometimes necessary to take it all your life. 
  • 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 an irregular menstrual cycle.
  • Thyroid hormones:- L-thyroxine is prescribed to treat hypothyroidism. Initially, a minimum dose is used, gradually increasing it until a therapeutic effect is achieved.

Additionally, combinations of vitamins and minerals help to strengthen the immune system. With pronounced weight loss, you 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, prevent gastrointestinal problems and other complications.

Diet during the treatment regimen

While taking medicines, it is necessary to maintain a balanced diet. You 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.

More about Treatment

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 labour 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. 

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, hypotension are common
  • Middle-stage:- Causes hypothyroidism (persistent lack of thyroid hormones), weight loss, a sharp decrease in blood pressure.
  • Later-stage:- There are problems with sexual activity, anemia, 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.

FAQ

What are the risk factors for Sheehan's syndrome?

Obstetricians-gynecologists predicts the following risk factors for the development of Sheehan's syndrome:

  • Blood clotting disorders in pregnant women (in particular, Low platelet level)
  • Peripheral edema
  • Gestational hypertension (high blood pressure)
  • Pre-eclampsia high blood pressure and proteinuria
  • Increased hemolysis (the breakdown of RBC)
  • Placenta previa
  • Multiple pregnancies (twins or triplets)

What is the prevention of Sheehan's syndrome?

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

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:

  • Dysfunction of the heart and vascular system
  • Adrenal insufficiency
  • hypochromic anemia
  • hypoglycemia ( low blood sugar)

How rare is Sheehan's syndrome?

  • According to research, Sheehan's syndrome is rare 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. You cannot catch it from someone who has the disease.

Top Doctors For Sheehan’s Syndrome Treatment

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Dr. J. Dhivyalakshmi Endocrinology | Gender: Female | Experience: 7 years | Hospital: Sri Ramachandra Medical Centre (SRMC)
Dr. Archana Juneja Endocrinology | Gender: Female | Experience: 15 years | Hospital: Kokilaben Dhirubhai Ambani Hospital
Dr. Dheeraj Kapoor Endocrinology | Gender: Male | Experience: 15 years | Hospital: Kokilaben Dhirubhai Ambani Hospital
Dr. C. M. Batra Endocrinology | Gender: Male | Experience: 30 years | Hospital: Apollo Indraprastha
Dr. Elif Karacanoğlu Endocrinology | Gender: Female | Experience: 15 years | Hospital: Hisar Intercontinental
Dr. Khalid Alghofaili Endocrinology | Gender: Male | Experience: 10 years | Hospital: Saudi German Hospital
Dr. Sudhanshu Dev Singh Endocrinology | Gender: Male | Experience: 10 years | Hospital: Saudi German Hospital
Dr. Ambanna Gowda Endocrinology | Gender: Male | Experience: 9 years | Hospital: Fortis Hospital, Bengaluru
Dr. Yavuz Selim Demir Endocrinology | Gender: Male | Experience: 26 years | Hospital: Medicana International Hospital, Istanbul
Dr. Süleyman Ipekçi Endocrinology | Gender: Male | Experience: 18 years | Hospital: Hisar Intercontinental

Top Hospitals For Sheehan’s Syndrome Treatment

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Columbia Asia Hospital, Bengaluru Columbia Asia is an international healthcare group operating a chain of modern hospitals across Indi
Gleaneagles Global Hospital, Mumbai Gleneagles Global Hospital, Mumbai offers end-to-end clinical, surgical and diagnostic services. The
Peerless Hospital, Kolkata 400 bed Multi-Specialty Peerless Hospital & B.K.Roy Research Centre is build around the core princip
Ramesh Hospital, Vijayawada Ramesh Hospital’s Main Centre flagship unit, located in the heart of Vijayawada, has been offering
Seven Hills Hospital, Mumbai SevenHills Group has over two decades of experience in the healthcare sector, and is known for provi
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