Severe blood loss during childbirth can deprive the body of oxygen and damage the pituitary gland.
Sheehan's syndrome is a condition that affects women who lose a life-threatening amount of blood in childbirth or who have severe low blood pressure during or after childbirth, which can deprive the body of oxygen. This lack of oxygen that causes damage to the pituitary gland is known as Sheehan's syndrome.
Sheehan's syndrome causes the pituitary gland to not produce enough pituitary hormones (hypopituitarism). Also called postpartum hypopituitarism, Sheehan's syndrome is rare in industrialized nations, largely because care during pregnancy and childbirth is better than in developing countries.
Treatment of Sheehan's syndrome involves lifelong hormone replacement therapy.
Signs and symptoms of Sheehan's syndrome typically appear slowly, after a period of months or years. But sometimes problems appear right away, such as the inability to breast-feed.
Signs and symptoms of Sheehan's syndrome occur because of having too little of the hormones the pituitary gland produces. Signs and symptoms include:
For many women, Sheehan's syndrome symptoms are often thought to be caused by other things. Fatigue, for instance, is commonly experienced by new mothers. You might not realize you have Sheehan's syndrome until you need treatment for thyroid or adrenal insufficiency.
It's also possible to remain relatively symptom-free if you have Sheehan's syndrome, depending on the extent of damage to the pituitary gland. Some women live for years without knowing that their pituitary gland isn't working properly. Then an extreme physical stressor, such as severe infection or surgery, triggers an adrenal crisis, a serious condition in which your adrenal glands produce too little of the hormone cortisol.
Sheehan's syndrome is caused by severe blood loss or extremely low blood pressure during or after childbirth. These factors can be particularly damaging to the pituitary gland, which enlarges during pregnancy, destroying hormone-producing tissue so that the gland can't function normally.
Pituitary hormones regulate the rest of your endocrine system, signaling other glands to increase or decrease production of the hormones that control metabolism, fertility, blood pressure, breast milk production and many other vital processes. A lack of any of these hormones can cause problems throughout the body.
Hormones from the front of your pituitary gland include:
Adrenocorticotropic hormone (ACTH). This hormone stimulates your adrenal glands to produce cortisol and other hormones. Cortisol helps your body deal with stress and influences many body functions, including blood pressure, heart function and your immune system.
A low level of adrenal hormones caused by damage to the pituitary gland is called secondary adrenal insufficiency.
Any condition that increases the chance of severe blood loss (hemorrhage) or low blood pressure during childbirth, such as being pregnant with multiples or having a problem with the placenta, can increase the risk of Sheehan's syndrome.
Hemorrhage is a rare childbirth complication, however, and Sheehan's syndrome is even more uncommon. Both risks are greatly reduced with proper care and monitoring during labor and delivery.
Because pituitary hormones control many aspects of your metabolism, Sheehan's syndrome can cause many problems, including:
The most serious complication is adrenal crisis, a sudden, life-threatening state that can lead to extremely low blood pressure, shock, coma and death.
Adrenal crisis usually occurs when your body is under marked stress — such as during surgery or a serious illness — and your adrenal glands produce too little of a powerful stress hormone (cortisol).
Because of the potentially serious consequences of adrenal insufficiency, your doctor is likely to recommend that you wear a medical alert bracelet.
Diagnosing Sheehan's syndrome can be difficult. Many symptoms overlap with those of other conditions. To diagnose Sheehan's, your doctor likely will:
Treatment for Sheehan's syndrome is lifelong hormone replacement therapy for the hormones you're missing. Your doctor might recommend one or more of the following medications:
Corticosteroids. Hydrocortisone (Cortef) or prednisone (Rayos), replace the adrenal hormones that aren't being produced because of an adrenocorticotropic hormone (ACTH) deficiency.
You'll need to adjust your medication if you become seriously ill or experience major physical stress. During these times, your body would ordinarily produce extra cortisol — a stress hormone. The same kind of dosage fine-tuning may be necessary when you have the flu, diarrhea or vomiting, or have surgery or dental procedures.
Dosage adjustments might also be necessary during pregnancy or with marked weight gain or weight loss. Taking the appropriate amount can help avoid the side effects associated with high doses of corticosteroids.
Levothyroxine (Levoxyl, Synthroid, others). This medication boosts deficient thyroid hormone levels caused by low or deficient thyroid-stimulating hormone (TSH) production.
If you change brands, let your doctor know to ensure you're still receiving the right dosage. Also, don't skip doses or stop taking the drug because you're feeling better. If you do, signs and symptoms will gradually return.
Estrogen. This includes estrogen alone if you've had your uterus removed (hysterectomy) or a combination of estrogen and progesterone if you still have your uterus.
Estrogen use has been linked to an increased risk of blood clots and stroke in women who still make their own estrogen. The risk should be less in women who are replacing missing estrogen.
Preparations containing luteinizing hormone (LH) and follicle-stimulating hormone (FSH), also called gonadotropins, might make future pregnancies possible. These can be delivered by injection to stimulate ovulation.
After age 50, around the time of natural menopause, discuss the risks and benefits of continuing to take estrogen or estrogen and progesterone with your doctor.
Your endocrinologist is likely to test your blood regularly to make sure that you're getting adequate — but not excessive — amounts of hormones.
If your primary care provider suspects Sheehan's syndrome, you'll likely be referred to a doctor who specializes in hormonal disorders (endocrinologist).
Here's information to help you get ready for your appointment:
When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:
Bring medical records from previous pregnancies, especially those on labor and delivery. If possible, take a family member or friend to help you remember the information you're given.
For Sheehan's syndrome, basic questions to ask your doctor include:
Don't hesitate to ask other questions.
Your doctor is likely to ask you questions, including:
April 9th, 2021