Postpartum hypopituitarism

Alternative names
Sheehan’s syndrome; Postpartum pituitary insufficiency; Hypopituitarism Syndrome

Definition
Sheehan’s syndrome is a condition that may occur in a woman who has a severe uterine hemorrhage during childbirth. The resulting severe blood loss causes tissue death in her pituitary gland and leads to hypopituitarism following the birth.

Causes, incidence, and risk factors

If a woman’s pituitary gland is starved of blood because she bled severely during childbirth, the gland may lose its ability to function properly. The pituitary gland, which is located at the base of the brain, is responsible for producing a variety of hormones that help regulate growth, reproduction, and metabolism.

Sheehan’s syndrome is very rare now because of wide access to good obstetrical care.

Conditions that increase the risk of an obstetric hemorrhage and thus of Sheehan’s syndrome include multiple pregnancies (twins or triplets) and abnormalities of the placenta.

Symptoms

The pituitary gland normally produces hormones that stimulate breast milk production, growth, reproductive functions, the thyroid, and the adrenal glands. A lack of these hormones results in a variety of symptoms related to all of these areas.

These symptoms may include:

     
  • Inability to breast-feed (breast milk never “comes in”)  
  • Fatigue  
  • Loss of pubic and axillary hair  
  • Amenorrhea, or lack of menstrual bleeding  
  • Low blood pressure

Signs and tests

     
  • Blood tests are performed to measure hormone levels.  
  • A CT scan of the head may be recommended to rule out other abnormalities of the pituitary such as a tumor.

Treatment

The treatment for pituitary insufficiency is lifelong hormone substitute medication, including estrogen and progesterone hormone replacement. 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 because of the lack of thyroid and adrenal hormones, which allow the body to react to stress or infections.

Prevention

Extreme hemorrhage during birth is often preventable by modern medical care. Otherwise, Sheehan’s syndrome is not predictable or preventable.

Johns Hopkins patient information

Last revised: December 3, 2012
by Gevorg A. Poghosian, Ph.D.

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