Sheehan syndrome

• Alternative Names

  Postpartum hypopituitarism; Postpartum pituitary insufficiency; Hypopituitarism Syndrome

• Causes, incidence, and risk factors

  Severe bleeding during childbirth can cause tissue death in the pituitary gland, which may cause the gland to lose its ability to function properly.

  The pituitary gland is located at the base of the brain. It normally produces hormones that stimulate breast milk production, growth, 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 pregnancies (twins or triplets) and problems with the placenta, 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: Symptoms other than inability to breast feed may not develop for several years after the delivery.

• Signs and tests
  • Blood tests to measure hormone levels
  • CT scan of the head to rule out other pituitary problems, such as a tumor
• Treatment

  Treatment involves estrogen and progesterone hormone replacement therapy, which must be taken for the rest of your life. Thyroid and adrenal hormones also must be taken.

• 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

  Malee MP. Pituitary and adrenal disorders in pregnancy. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 39.

  Cunnigham FG, Leveno KL, Bloom SL, et al . Obstetrical hemorrhage. In: Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 22nd ed. New York, NY; McGraw-Hill; 2005:chap 35.

Review Date: 10/28/2008

Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.