Everything You Should Know About Sheehan’s Syndrome

Sheehan’s syndrome is a rare medical condition that affects women who bleed excessively during childbirth. It occurs when the pituitary gland is damaged due to severe hypotension or shock caused by a massive haemorrhage during or after delivery.

The loss of blood during the delivery causes tissue death in the pituitary gland. As the blood pressure dips during or after labour, there is a lack of blood and oxygen in the pituitary gland. This lack of oxygen causes damage to the pituitary gland. Such a condition is known as Sheehan’s syndrome.

The pituitary gland lies at the base of the brain and produces hormones that oversee the function of your body’s other glands. This master gland is more vulnerable to injury in labour as it grows bigger to almost double its size during pregnancy.

Also known as postpartum hypopituitarism, Sheehan’s syndrome is named after the British pathologist, Harold Leeming Sheehan, who first explained this disorder in 1937.

Symptoms of Sheehan’s Syndrome

The symptoms of Sheehan’s syndrome may vary from woman to woman. Some of the most common symptoms of Sheehan’s syndrome are-

• Fatigue
• Dizziness
• Inability to produce breast milk
• Irregular or absent menstrual periods
• Thinning of the vaginal lining
• Decreased libido
• Reduction in size of breasts
• Loss of pubic and underarm hair
• Low blood pressure
• Weight loss or gain
• Loss of strength in muscles
• Loss of hair in armpits and pubic hair
• Constipation
• Diabetes insipidus, a condition in which the kidneys produce an abnormally huge volume of urine
• Irregular or fast heartbeat
• Wrinkles around the lips and the eyes

Causes of Sheehan’s Syndrome

Sheehan’s syndrome is rare in developed countries as advanced maternal care usually prevents extreme blood loss during delivery. However, this condition is still common in developing countries like India where women still bleed heavily during childbirth.

The destruction of the anterior pituitary gland’s cells due to oxygen starvation, at the time of childbirth, is the main cause of Sheehan’s syndrome.

The presence of disseminated intravascular coagulation is also another cause of Sheehan’s syndrome.

Does Sheehan’s Syndrome Affect Body Functioning?

The pituitary gland regulates the rest of your endocrine system and is responsible for signalling other glands to rev up or lessen the production of the hormones that control some of the vital processes like fertility, blood pressure, metabolism and breast milk production. Hence, if the pituitary gland fails to produce any of these hormones, they can cause different types of problems throughout the body. It affects the production of the following pituitary hormones:

• Thyroid-stimulating hormone (TSH): It directs your thyroid gland to produce its hormones that regulate your metabolism.
• Luteinizing hormone (LH) and Follicle-stimulating hormone (FSH): These hormones regulate your menstrual cycle and egg production.
• Growth hormone (GH): It controls organ and tissue growth. Besides, it is responsible for maintaining muscle mass.
• Adrenocorticotropic hormone (ACTH): It stimulates your adrenal glands to release cortisol and other stress hormones.
• Prolactin: It stimulates the production of breast milk.

Risk Factors of Sheehan’s Syndrome

The factors that make a woman more likely to have severe blood loss during childbirth are:

• placental abruption, a condition in which the placenta that nourishes the unborn baby gets detached from the uterus.
• placenta previa, a condition when the placenta partly or fully covers the cervix, the bottom part of the uterus that connects to the vagina.
• giving birth to a large baby, weighing more than 8.8 pounds (4,000 grams), or having multiples, like twins.
• preeclampsia (high blood pressure during pregnancy)
• assisted labour (a forceps or vacuum-assisted delivery)

Diagnosis of Sheehan’s Syndrome

Diagnosis of Sheehan’s syndrome is mostly done by:

1. Medical History: You should inform your doctor about any complications during childbirth, whether you faced any lactation problem or failed to begin menstruating after delivery.

2. Blood Tests: Blood tests can be done for chronic cases in order to detect the levels of the pituitary gland.

3. Pituitary Hormone Stimulation Test: It involves injecting hormones and running repeated blood tests in order to determine the response of the pituitary glands.

4. Imaging Tests: Imaging tests like an MRI scan or CT scan can check the size of your pituitary gland and look into it.

Treatment for Sheehan’s Syndrome

There’s only one treatment for Sheehan’s syndrome and that’s lifelong hormone replacement therapy. You’ll need to stay on most of these hormones for life:

• Corticosteroids like prednisone or hydrocortisone: It replaces adrenal hormones.
• Levothyroxine: This medication increases the levels of the hormones your thyroid gland makes.
• Estrogen and progesterone: The doctor cannot evaluate these hormone levels until the age of menopause. Oral contraceptives can be a way of replacing these hormones.

It is advisable to consult a doctor immediately if you have Sheehan’s syndrome. Living with Sheehan’s syndrome untreated can be life-threatening. If you are diagnosed with Sheehan’s syndrome and wish to conceive, you should discuss your fertility options with your gynaecologist.