Sheehan's syndrome

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Pituitary gland anatomic relations.
Pitutiary gland physiology.
  • Also known as postpartum hypopituitarism
  • Caused by pituitary hypoperfusion and infarction usually in the setting of postpartum hemorrhage
  • During pregnancy there is enlargement of the pituitary gland predisposing it to ischemia in low-flow states

Clinical Features

  • Symptoms consistent with adrenal insufficiency, hypothyroidism and hypogonadism
    • Inability to lactate
    • Amenorrhea or oligomenorrhea
    • Fatigue
    • Cold intolerance
    • Lethargy
    • Weight loss
  • Can occur any time from the immediate postpartum period to years after birth

Differential Diagnosis

Adrenal crisis


  • Evaluation of serum prolactin levels is not performed as it is difficult to differentiate low from normal serum prolactin levels


  • Workup should include testing of all anterior pituitary hormones
  • Patients should be evaluated and treated for adrenal insufficiency immediately as this can worsen pre-existing hypotension
  • Other pituitary hormones can be tested for 4-6 weeks after the initial insult



  • Currently no treatment is available but there is an ongoing small open-label pilot study looking at using recombinant human prolactin


See Also

External Links