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Sheehan syndrome

Sheehan syndrome is a condition that can occur in a woman who bleeds severely during childbirth. Sheehan syndrome is a type of hypopituitarism .

Alternative Names

Postpartum hypopituitarism; Postpartum pituitary insufficiency; Hypopituitarism Syndrome

Causes, incidence, and risk factors

Severe bleeding during childbirth can result in tissue death in the pituitary gland. This causes the gland to lose its ability to work properly.

The pituitary gland is at the base of the brain. It makes hormones that stimulate growth, production of breast milk, reproductive functions, the thyroid, and the adrenal glands. A lack of these hormones can lead to a variety of symptoms.

Conditions that increase the risk of bleeding during childbirth and Sheehan syndrome include multiple pregnancy (twins or triplets) and problems with the placenta. The placenta is the organ that develops during pregnancy to feed the fetus.

Sheehan syndrome is very rare.

Symptoms

Symptoms of Sheehan syndrome may include:

  • Inability to breast-feed (breast milk never "comes in")
  • Fatigue
  • Lack of menstrual bleeding
  • Loss of pubic and axillary hair
  • Low blood pressure

Note: Other than not being able to breast feed, symptoms may not develop for several years after the delivery.

Signs and tests

  • Blood tests to measure hormone levels
  • MRI of the head to rule out other pituitary problems, such as a tumor

Treatment

Treatment involves estrogen and progesterone hormone replacement therapy. These hormones must be taken at least until the normal age of menopause. Thyroid and adrenal hormones must also be taken. These will be needed for the rest of your life.

Expectations (prognosis)

The outlook with early diagnosis and treatment is excellent.

Complications

This condition can be life threatening if not treated.

Prevention

Extreme bleeding during childbirth can often be prevented by proper medical care. Otherwise, Sheehan syndrome is not preventable.

References

Cunningham FG, Leveno KL, Bloom SL, et al . Obstetrical hemorrhage. In: Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 23rd ed. New York, NY; McGraw-Hill; 2009:chap 35.

Malee MP. Pituitary and adrenal disorders in pregnancy. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 41.

Updated: 11/8/2012

Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.


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