Sheehan's syndrome

Background

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

• Addison's disease
• Congenital adrenal hyperplasia
• Shock
• Sepsis
• Pituitary apoplexy
• Sheehan's syndrome

Evaluation

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

Workup

• 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

Management

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

See Also

• Pregnancy
• Pituitary apoplexy