Symptoms, diagnosis and treatment of Sheehan’s Syndrome

Initially described in 1937 by British Pathologist Harold Leeming Sheehan, Sheehan’s syndrome is a rare complication of women losing an exceptionally large amount of blood during or after childbirth. That level of blood loss in itself is fortunately a rare occurrence in industrialised nations but more of a concern in developing countries. 

During pregnancy and increased amount of oestrogen causes the pituitary gland to enlarge and it is this that makes it very sensitive to a sudden decrease in blood flow. In addition the massive blood loss results in a sudden fall in blood pressure which deprives the pituitary gland of oxygen and leads to tissue death (necrosis) and this causes the gland to permanently lose its ability to produce sufficient pituitary hormones. This is called “Hypopituitarism”

As the function of the pituitary gland ranges from stimulating the production of breast milk to stimulating the thyroid and adrenal glands the symptoms of hypopituitarism are of both wide ranging and highly individual in their severity.

Two key signs may be a lack of breast milk and a failure of periods to recommence or to be very intermittent, However, other symptoms are non-specific – e.g. weakness, fatigue, low blood pressure (In fact all symptoms of hypothyroidism). This makes the condition difficult to diagnose but investigations will normally include:

• Your doctor being made aware of any complications in childbirth
• Carrying out blood tests to check your pituitary hormone levels
• Referral to an endocrinologist to carry out a pituitary hormone stimulation test
• A MRI scan to rule out the existence of a pituitary tumour which causes similar symptoms. Sometimes the MRI scan will show a small pituitary gland reflecting the previous damage.

If Sheehan’s syndrome is diagnosed,  treatments will be lifelong hormone replacement therapy which may include corticosteroids to replace your adrenal hormones, oestrogen to replace ovarian hormones and Levothyroxine to boost your thyroid hormone levels. Some studies also suggest the replacement of growth hormone can help some patients with the correct the body’s muscle to fat ratio, lower cholesterol levels and maintain bone mass.

As Sheehan’s syndrome develops slowly it may only become apparent when the body is stressed by surgery or infection later in life - at which point an adrenal crisis may occur. This needs immediate treatment as it can be life threatening.

If you would like to share your experience of this or other pituitary conditions you may like to visit the Pituitary Foundation on www.pituitary.org.uk

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