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Sheehan's Syndrome

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Sheehan's syndrome can be described as hypopituitarism caused by pituitary necrosis. This pituitary necrosis occurs due to blood loss and hypovolemic shock associated with postpartum bleeding. Patients with Sheehan's syndrome commonly present with agalactorrhea and amenorrhea and can also suffer from cold intolerance due to secondary hypothyroidism.

4 KEY FACTS

Patients with Sheehan's syndrome typically present with postpartum agalactorrhea (absence of lactation) and sometimes amenorrhea. As a result of postpartum hemorrhage, ischemic pituitary necrosis occurs, and hormone secretion from the anterior pituitary is usually interrupted. Typically patients lose prolactin (PRL), growth hormone (GH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), adrenocorticotropic hormone (ACTH), and/or thyroid stimulating hormone (TSH) secretion. Occasionally, secretion of the posterior pituitary hormones oxytocin (OXT) and antidiuretic hormone/arginine vasopressin (ADH/AVP) can also be disrupted.

As patients develop hypopituitarism in Sheehan’s syndrome, one of the most common initial symptoms is agalactorrhea when attempting to breastfeed. This symptom occurs because of the loss of prolactin, which is responsible for regulating milk production during the postpartum period.

Commonly, women with Sheehan's syndrome also complain of amenorrhea or oligomenorrhea. This disruption in normal menstruation occurs due to a loss of gonadotropins like FSH and LH.

Hypopituitarism in Sheehan's syndrome can lead to decreased TSH secretion, yielding a lack of thyroid hormones. Without TSH, the thyroid gland cannot be stimulated, resulting in a decreased release of triiodothyronine (T3) and thyroxine (T4). Thus, Sheehan's syndrome can lead to a form of secondary (2º) hypothyroidism. Patients often complain of cold intolerance.

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