What is Sheehan Syndrome?
Sheehan Syndrome is a pathological condition characterized by abnormal and even sometimes life threatening amount of blood loss during delivery of a child by a female or have severe hypotension at the time or immediately after childbirth.
Because of this, there is severe depravation of oxygen in the body which tends to damage the pituitary gland resulting in the gland not producing enough pituitary hormones.
Sheehan Syndrome is pretty rare in the United States and other developed countries because of better gynecological and obstetrics care as compared to some of the underdeveloped nations like those in the Africa and Latin America.
The mainstay of treatment for Sheehan Syndrome is hormone replacement therapy through the entire period of the life of the patient suffering from Sheehan Syndrome.
What are the Causes of Sheehan Syndrome?
The root cause of Sheehan Syndrome is abnormal loss of blood during delivery of a child by a female associated with severe hypotension at the time or immediately after delivery. All these factors lead to abnormalities in the pituitary gland which tends to enlarge when the female is pregnant.
Because of these factors the pituitary gland gets damaged and the hormone producing tissue gets destroyed and the gland is unable to function normally. The function of the pituitary hormones is to control and regulate the endocrine system. These hormones signal the other hormones present in the endocrine system which control production of breast milk, regulate metabolism, control blood pressure to increase or reduce their production.
Thus, an abnormality in any of these glands or hormones may cause abnormality in functioning of many hormones in the body and can cause problems throughout the body.
Some of the hormones that can get affected by Sheehan Syndrome are the growth hormones, the thyroid stimulating hormones, follicle stimulating hormones, luteinizing hormone, and adrenocorticotropic hormone. An abnormality in the production of any of these hormones may have detrimental affects on the female suffering from Sheehan Syndrome.
What are the Symptoms of Sheehan Syndrome?
The symptoms of Sheehan Syndrome tend to occur slowly and over a period of time. It may take even up to years for the first symptoms of Sheehan Syndrome to appear but in some cases symptoms may appear right away like inability for the new mother to breast feed the baby. Some of the common symptoms of Sheehan Syndrome are:
- Problems with breast feeding
- Menstrual cycle abnormalities
- Abnormalities in cognitive function
- Weight gain
- Persistent fatigue post delivery
- Irregular heartbeat
There are times when females are not even able to recognize that they have Sheehan Syndrome since some of the symptoms are so common especially for a new mother that until some major symptoms appear such as an adrenal crisis after a surgery or a major stressor only then they come to know that they are suffering from Sheehan Syndrome.
In some cases where there is minimal damage to the pituitary gland the female may remain symptom free and may not even know that their pituitary gland is not working properly.
How is Sheehan Syndrome Diagnosed?
Since the symptoms of Sheehan Syndrome are quite similar to a number of different medical conditions and since this condition is pretty rare, it is very difficult to arrive at a diagnosis of Sheehan Syndrome easily.
In order to diagnose Sheehan Syndrome, the treating physician will begin by taking a detailed history of the patient. The patient will be asked if she ever had a difficult delivery of a child in the remote past where she had too much bleeding or were there any other complications during pregnancy or at the time of delivery.
The physician will also inquire as to whether the female was able to breast feed the baby or not. The details of these two questions are of extreme importance when diagnosing Sheehan Syndrome. Following this, a complete blood test will be conducted of the patient where the levels of the pituitary hormones will be checked. In cases of Sheehan Syndrome, these levels will be significantly low.
Once Sheehan Syndrome is suspected advanced radiological studies in the form of CT or MRI of the pituitary gland will be conducted to look for any damage to the pituitary gland which in cases of Sheehan Syndrome will show significant abnormalities thus confirming the diagnosis of Sheehan Syndrome.
How is Sheehan Syndrome Treated?
The mainstay of treatment for Sheehan Syndrome is life long administration of hormone replacement therapy. Additionally, steroids may also be recommended to replace the deficient adrenal hormones. The dosage of the medications will be periodically assessed and changed in case if the patient is suffering from any other medical condition or the patient needs to undergo a dental procedure.
In some cases, dose adjustments will be required if the patient gets pregnant again or if the patient has significant weight loss or weight gain. Levothyroxine is yet another medication that is quite useful in treatment of Sheehan Syndrome.
Additionally, patients will be given estrogen therapy if they have had a hysterectomy done, or a combination of estrogen and progesterone in case if the uterus is still present for treatment of Sheehan Syndrome.
A risk that is often associated with estrogen and progesterone therapy is the increased risk of blood clots and stroke especially in females who are still making their own estrogen apart from the supplement that is being given.
Studies have shown that replacing growth hormone in females with Sheehan Syndrome is quite effective in improving the quality of life of the female with Sheehan Syndrome.