Sheehan syndrome is a rare condition affecting the pituitary gland during or after childbirth. Damage occurs to the pituitary gland due to a reduction in blood flow. As this damage affects the gland’s function, it may produce significantly less pituitary hormones.
This condition, which doctors also call postpartum hypopituitarism, involves damage to the pituitary gland following childbirth. A lack of blood flow to the pituitary gland, typically due to excessive bleeding, causes it to gradually stop functioning. As a result, a person may begin to experience symptoms relating to low pituitary hormone levels. The name of the condition derives from Dr. Harold Leeming Sheehan, a British physician.
This article will discuss Sheehan syndrome, including its symptoms, diagnosis, and treatment options.
Sheehan Syndrome occurs when a person experiences damage to their pituitary gland during or after childbirth. This can occur due to significant blood loss or low blood pressure during or after the birth. This results in the pituitary gland not receiving a sufficient blood supply. When the gland does not receive adequate blood flow for long enough, the cells become starved of oxygen and become damaged.
- luteinizing hormone
- adrenocorticotropic hormone
- growth hormone
As damage may occur to the pituitary gland, a person with Sheehan syndrome will experience a reduction in the function of this gland. This can affect the production of some, if not all, of these hormones, leading to the symptoms of the condition.
During pregnancy, a person’s pituitary gland significantly increases in size due to a rise in the amount of estrogen. This also causes an increase in the volume of blood that passes through it. As such, this makes the pituitary gland vulnerable to a severe drop in blood pressure, sometimes known as a shock, and excessive bleeding, which may induce a shock.
This sudden decrease in blood supply can result in tissue death to cells of the gland and a subsequent loss of pituitary function. Typically, this only affects the anterior, or front, part of the pituitary gland. According to health experts, damage must occur to roughly 75–90% of the pituitary gland before symptoms of Sheehan syndrome begin.
A 2018 paper found that people with Sheehan syndrome also reported experiencing more pregnancy complications, suggesting that these could be possible risk factors. These complications included:
- pregnancy loss
- complications with the placenta
- uterine rupture
- pregnancy with more than one fetus
Further conditions can increase the risk of a person’s blood pressure dropping, reducing blood flow to the pituitary gland during childbirth. These can include:
- Placenta previa: This is where the placenta covers the opening of the cervix.
- Placental abruption: This occurs when the placenta either partially or completely separates from the uterus.
- Preeclampsia: This condition describes when a person’s blood pressure suddenly rises during pregnancy.
- Giving birth to multiple newborns or a baby weighing 8.8 pounds or more
Sheehan syndrome symptoms can vary depending on the damage to the pituitary gland and how this affects the body’s hormones. In severe cases, where there has been significant damage to the pituitary gland, a person may experience symptoms very soon after childbirth. In cases where there is less damage to the gland, symptoms may develop gradually over time.
- a difficulty or inability to lactate
- menstruation changes
- decreased sex drive
- decreased breast size
- thinning of the vaginal lining, sometimes causing pain during intercourse
- hair loss
- low blood pressure
- dry or wrinkling skin
- weight gain
- increased insulin sensitivity
Diagnosing Sheehan syndrome can be difficult for doctors, as symptoms can emerge gradually and look similar to other conditions. Initially, a doctor will ask a person about their medical history and any complications with past childbirths.
They may also ask if a person experienced trouble producing breast milk and did not restart menstruation after childbirth, two common signs of the condition. With this information, a doctor may then order the following
- Blood tests: These tests will show any unusual hormone levels that indicate the pituitary gland is not functioning properly.
- Anterior pituitary hormone test: Measures the levels of certain hormones in the body.
- MRI: This imaging test will show any damage or changes to the structure of the pituitary gland that can help confirm a diagnosis of Sheehan syndrome.
A person with Sheehan syndrome might need lifelong treatment since their pituitary gland may no longer function properly. Treatment aims to replace the hormones in the body that the pituitary gland cannot adequately produce. The exact treatment can vary depending on what hormone levels are atypical but may include:
- Corticosteroids: These medications include prednisone or hydrocortisone and replace the adrenal hormones.
- Levothyroxine: This medication helps increase thyroid hormones that may be deficient if the pituitary gland is not producing enough thyroid-stimulating hormone.
- Estrogen and progesterone: A person may need to take these medications until they reach an age that menopause would usually occur. If a person has had a hysterectomy, a doctor will prescribe only estrogen, while someone with a uterus will take both hormones.
- Growth hormone: Bringing these hormones back to a typical level can help improve muscle mass that may have decreased and improve cholesterol levels.
One of the more serious complications of Sheehan’s syndrome is the possibility of experiencing an adrenal crisis. During times of physical stress, such as injury, illness, or surgery, the body requires a hormone called cortisol to function in increased amounts. When it does not have enough to deal with the physical stresses, the body may go into shock, and in serious cases, this can be life threatening.
A person with Sheehan’s syndrome may not be able to produce enough cortisol without treatment. A doctor can help create a plan for adjusting medications to lessen the risk of adrenal crisis. They may also recommend wearing a medical alert tag.
Although less common, a 2017 study found that in rare cases, psychosis can be a complication of Sheehan syndrome due to the hormonal imbalances it causes.
Sheehan syndrome describes a condition that occurs following damage to the pituitary gland during or after childbirth. The pituitary gland plays a key role in many functions of the body, and when it does not function properly, a person can experience a variety of symptoms. Treatment for Sheehan syndrome is lifelong, but correcting the hormone deficiencies can relieve symptoms and allow a person to live a healthy, typical life.