What is Sheehan’s syndrome?
Sheehan’s syndrome is a condition that occurs when the pituitary gland is damaged during childbirth. It is caused by excessive blood loss (hemorrhage) or extremely low blood pressure during or after childbirth. Lack of blood deprives the pituitary of the oxygen it needs to function properly.
The pituitary gland is at the improper of the brain. It produces hormones that monitor the function of the other glands in your body. That is why it is identified as “the master gland”. This gland is more vulnerable to injury during labor because it increases in size during pregnancy.
When the pituitary doesn’t work as well as it should, the glands it controls, including the thyroid and adrenal glands, can’t release enough hormones. Sheehan’s syndrome affects the production of these pituitary hormones:
- Thyroid-stimulating hormone (TSH) directs the thyroid gland to produce its hormones, which regulate its metabolism.
- Luteinizing hormone (LH) helps regulate your menstrual cycle and egg production, along with FSH.
- Follicle Stimulating Hormone (FSH) helps regulate your menstrual cycle and egg production, along with LH.
- Growth hormone (GH) controls the growth of organs and tissues.
- Adrenocorticotropic hormone (ACTH) stimulates the adrenal glands to release cortisol and other stress hormones.
- Prolactin stimulates milk production.
Sheehan’s syndrome is also called postpartum hypopituitarism.
Symptoms of Sheehan’s syndrome
The pituitary gland produces hormones that stimulate breast milk production, growth, reproductive functions, the thyroid, and the adrenal glands. The lack of these hormones can cause a variety of symptoms. While some women may experience early symptoms, such as difficulty breastfeeding or the inability to breastfeed (breast milk never “comes in”), in most cases the signs and symptoms of Sheehan’s syndrome advance slowly, sometimes over a period of months or even years.
For many, symptoms become apparent when the body is stressed by infection or surgery sometime after delivery. This type of stressor can lead to an adrenal crisis. Symptoms that may develop include:
- Pain in the joints
- Amenorrhea (lack of menstrual bleeding)
- Oligomenorrhea (infrequent menstrual periods)
- Hot flushes
- Decreased libido
- Loss of pubic and armpit hair
- Low blood pressure (hypotension)
- Slow mental functioning
- Weight gain
- Difficulty staying warm
- Contraction of the breasts
Causes of Sheehan’s syndrome
Sheehan’s syndrome is caused by severe blood loss or tremendously low blood pressure through or after delivery. These factors can be particularly harmful to the pituitary gland, which enlarges during pregnancy and destroys hormone-producing tissue so that the gland cannot function normally.
Pituitary hormones regulate the rest of your endocrine system, signalling other glands to increase or decrease the production of the hormones that control metabolism, fertility, blood pressure, breast milk production, and many other vital processes. Lack of any of these hormones can cause difficulties throughout the body.
The hormones from the front of your pituitary gland include:
- Growth hormone (GH): This hormone pedals bone and tissue growth and maintains the proper stability of muscle and fat tissue.
- Thyroid-stimulating hormone (TSH): This hormone stimulates the thyroid gland to produce key hormones that regulate your metabolism. The shortage of TSH results in an underactive thyroid gland (hypothyroidism).
- Luteinizing hormone (LH): In women, LH regulates estrogen.
- Follicle Stimulating Hormone (FSH): Working with LH, FSH helps to stimulate egg development and ovulation in women.
- Adrenocorticotropic hormone (ACTH): This hormone stimulates the adrenal glands to produce cortisol and other hormones. Cortisol assistances your body deal with stress and influences many bodily functions, including blood pressure, heart function, and immune system.
A low level of adrenal hormones caused by damage to the pituitary gland is called a secondary adrenal deficiency.
- Prolactin: This hormone adjusts the development of female breasts, as well as the production of breast milk.
The main risk factor for the development of Sheehan’s syndrome in pregnancy. The pathophysiological variations of the pituitary gland during pregnancy leave the gland weak to ischemia in the event of bleeding. Similar blood loss in non-pregnant women does not cause hypopituitarism, lending credence to this claim. Postpartum hemorrhage can be tough to predict due to the unpredictable nature of the delivery procedure.
It is known that women who have experienced a previous postpartum hemorrhage are three times more likely to have a postpartum hemorrhage in their subsequent pregnancies. A situation analysis concluded that those diagnosed with Sheehan’s syndrome have a significantly higher disseminated intravascular coagulation (DIC) score than their non-disease counterparts. The DIC score, which is based on the patient’s disease history, clinical symptomatology, and coagulation laboratories, may be an important determinant of the potential for disease development.
Women with Sheehan’s syndrome report more pregnancy complications than their counterparts who do not have it. The linked complications of stillbirth, miscarriage, abruption, placental retention, uterine rupture, hysterectomy, and multiple pregnancies are related to the potential for bleeding and are more frequently reported and known to cause potentially life-threatening bleeding risks.
Complications of Sheehan’s syndrome include:
- Adrenal crisis, a life-threatening condition in which the adrenal glands do not make enough cortisol, the stress hormone
- Low blood pressure
- Unexpected weight loss
- Irregular periods
Diagnosis of Sheehan’s syndrome
Diagnosing Sheehan’s syndrome can be difficult. Many symptoms overlap with those of other conditions. To diagnose Sheehan’s disease, your doctor will likely:
- Collect a complete medical history: It is important to mention any complications you had during labour, no matter how long ago you gave birth. Also, be sure to tell your doctor if you didn’t produce breast milk or were unable to start your period after delivery, two key signs of Sheehan’s syndrome.
- Take blood tests: Blood tests will check your levels of pituitary hormones.
- Request a pituitary hormone stimulation test: You may need a pituitary hormone stimulation test, which involves injecting hormones and doing repeated blood tests to see how your pituitary responds. This test is usually done after consulting a doctor who specializes in hormonal disorders (endocrinologist).
- Request imaging tests: You may also need imaging tests, such as an MRI or CT scan, to check the size of the pituitary gland and look for other possible reasons for your symptoms, such as a pituitary tumor.
Treatment of Sheehan’s syndrome
Treatment for Sheehan’s syndrome is a lifelong hormone replacement therapy for the hormones you are missing. Your specialist may mention one or more of the following medications:
- Corticosteroids: Hydrocortisone (Cortef) or prednisone (Rayos) replaces adrenal hormones that are not produced due to a deficiency of adrenocorticotropic hormone (ACTH).
You will need to adjust your medication if you become seriously ill or experience significant physical stress. During these times, your body would normally make extra cortisol, a stress hormone. The same type of dose adjustment may be necessary when you have the flu, diarrhoea or vomiting, or are undergoing surgery or dental procedures.
Dose changes may also be necessary during pregnancy or with obvious weight gain or loss. Taking the right amount can help avoid the side effects associated with high doses of corticosteroids.
- Levothyroxine (Levoxyl, Synthroid, others): This medicine increases deficient thyroid hormone levels caused by poor or deficient production of thyroid-stimulating hormone (TSH).
If you change brands, tell your doctor to make sure you keep getting the correct dose. Also, do not skip doses or stop taking the medicine because you feel better. If you do, the signs and symptoms will gradually return.
- Estrogen: This includes estrogen-only if you have had your uterus removed (hysterectomy) or a combination of estrogen and progesterone if you still have a uterus.
Estrogen use has been linked to an increased risk of blood clots and strokes in women who still produce their own estrogen. The risk should be lower in women who are replacing the missing estrogen.
Preparations containing luteinizing hormone (LH) and follicle-stimulating hormone (FSH), also called gonadotropins, may make future pregnancies possible. These can be given by injection to stimulate ovulation.
After age 50, around the time of natural menopause, talk with your doctor about the risks and benefits of continuing to take estrogen or estrogen and progesterone.
- Growth hormone: The growth hormone can improve the relationship between muscles and body fat, maintain bone mass, and lower cholesterol levels. The growth hormone is expensive and side effects can include stiff joints and fluid retention.