Have you heard about Sheehan`s syndrome, a rare medical condition of pregnancy that occurs after a high amount of blood lost?
Table of Contents
- 1 What Is Sheehan`s Syndrome?
- 2 What Is Sheehan`s Disease?
- 3 What Is The Most Common Cause Of Sheehan’s Syndrome?
- 4 What Are the Symptoms Sheehan`s Syndrome?
- 5 Risk Factors & Complications
- 6 How Is This Syndrome Diagnosed?
- 7 What Is the Treatment of Sheehan`s Syndrome?
- 8 Autoimmunity in Sheehan`s Syndrome
- 9 Outlook
- 10 Organizations Supporting this Syndrome
What Is Sheehan`s Syndrome?
Sheehan`s syndrome (SS) represents a hypopituitarism that characterizes ischemic necrosis because of hypovolemic shock and hemorrhage after birth.
Other terms that describe this medical condition from a medical point of view are:
- Pituitary postpartum necrosis.
- Simmonds syndrome.
- Postpartum hypopituitarism.
What Is Sheehan`s Disease?
Simmoands disease occurs when the pituitary gland is affected without being associated with pregnancy.
What Is The Most Common Cause Of Sheehan’s Syndrome?
The most frequent cause of SS is represented by necrosis of adenohypophyseal, which occurs due to birth complications that involve postpartum sepsis and abnormal bleeding.
Serious bleeding during birth might lead to the death of the tissue from the pituitary gland, which results in losing the ability of this particular gland to function.
The pituitary gland can be found at the brain`s base. Normally, it produces hormones which stimulate the break milk production, but it influences drainage and thyroid glands, development and reproductive functions as well. The lack of these particular hormones might result in lots of symptoms.
The supply of blood to the pituitary gland, which already has a bigger volume, is seriously compromised during the reduction of the volume of blood. A scarred, hypofunctional, atrophic gland occurs to our syndrome.
Women experiencing type 1 diabetes, especially women with pre-existing vascular illness, seems to be the most at risk. Other pathological mechanisms that are involved in the evolution of SS haven`t yet been completely studied.
Conditions which increase the risk of bleeding while pregnant and Sheehan`s syndrome include placental issues (the organ which develops while pregnancy evolves with an important role in the fetal development), and multiple pregnancies (twins or triplets).
What Are the Symptoms Sheehan`s Syndrome?
During the first couple of days after giving birth:
- Breast shrinkage.
- Decreased libido.
- Weight gain.
- Sudden weakness.
- Hot flashes.
- Irregular heartbeat.
Furthermore, syncopes appear more frequently and adynamic evolves.
Additional symptoms involve:
- Metabolic disorders.
- Thyroid and adrenal insufficiency.
Risk Factors & Complications
Any medical condition which increases the chance of serious blood loss or low blood pressure while birth, like being experiencing a multiple pregnancy or an issue with your placenta, might increase the risk of SS.
Hemorrhage is a rare birth complication, and Sheehan`s syndrome is an even more rare illness. Both risks are reduced a lot with correct health care and monitoring while in labor and during birth.
Due to the fact that pituitary hormones supervise lots of aspects of the human metabolism, SS might lead to several issues, which include:
- Low blood pressure.
- Irregular menstruation.
- Adrenal crisis, a severe medical condition in which the adrenal glands produce low amounts of hormone cortisol.
- Weight loss.
Adrenal Crisis Is Life-Threatening
The most severe complication that may occur is adrenal crisis, a life-threatening state which occurs suddenly and can result in shock, coma, low blood pressure and death.
Adrenal crisis generally appears when the body is under a lot of stress, like a severe illness or surgery, and the adrenal glands produce low amounts of cortisol, which is a powerful stress hormone.
Due to possible severe negative effects of adrenal insufficiency, the doctor will probably advise you to wear an alert bracelet.
How Is This Syndrome Diagnosed?
For the diagnosis of this condition, a lab evaluation will show either a partial hyposopathy or low thyroxine. Imaging studies (magnetic resonance imaging or and computerized tomography) are recommended in order to exclude mass lesions.
What Is the Treatment of Sheehan`s Syndrome?
The treatment of SS includes physiological doses of glucocorticoids, levotiroxine as well as sex hormones, with proper increases of glucocorticoid doses during periods that are more stressful.
Glucocorticoids are administered before levotiroxine. Sex hormones are administered in distinct formulas and distinct routes. – More info!
Ovulation induction with exogenous gonadotropins or pulsed GnRH might be required for women who are interested in becoming pregnant again. Certain women with low libido might require androgen supplementation.
Side Effects after Treatment
If the hormonal levels in the blood are supervised carefully, there shouldn`t occur any side effects. These might occur at times when the hormonal dosage is too low or too high, and should be corrected rather easily by adjusting the dosage of the relevant drugs. Any concerns or worries should be discussed with the doctor.
Autoimmunity in Sheehan`s Syndrome
The existence of anti-pituitary antibodies has been proven in certain patients with this condition, indicating that an autoimmune pituitary process might be involved in SS. Hypothalamic cell anti-hypothalamus antibodies have been described as well, however, not against arginine vasopressin AVP-secreting cells. Still, the importance of these specific antibodies is unclear, but they might kill the pituitary cells that remain with time. It`s suggested that sequestered antigens could trigger autoimmunity because of tissue necrosis, and might lead to delayed hypopituitarism in these particular patients. Still, other type of studies didn’t find anti-pituitary antibodies in this medical condition.
The hormonal treatment generally lasts for a long period of time and patients need regular visit to the doctor. If a patient takes steroids, he needs to acknowledge the rules of the sick days and perform emergency hydrocortisone injection, which additionally they also need to know how to use.
Organizations Supporting this Syndrome
Hormone Health Network Endocrine Society
Genetic and Rare Diseases (GARD) Information Center
PO Box 8126
Gaithersburg, MD 20898-8126
Phone: (301) 251-4925
Toll-free: (888) 205-2311
NIH/National Institute of Diabetes, Digestive & Kidney Diseases