Gonadotropin deficiency will often cause amenorrhea, oligomenorrhea, hot flashes, or decreased libido. Cessation of menses is an important indicator of Gonadotropin deficiency as a result of Sheehan’s syndrome. Growth hormone deficiency causes many vague symptoms including fatigue and decreased muscle mass.Growth-hormone deficiency is the most common symptom of hypopituitarism seen in Sheehan’s syndrome with a 90–100% occurrence seen in the Netherlands, Costa Rica, and Saudi Arabia. In these populations the occurrence of Cortisol, TSH, and gonadotropin deficiencies ranges from 50 to 100%. Hematological changes may occur due to a decrease in erythropoietin synthesis as a result of these cortisol and thyroid hormone decreases.Uncommonly, Sheehan syndrome may also appear acutely after delivery, mainly by hyponatremia. Electrolytic imbalances might result from the increased secretion of ADH, which may be caused by a decrease in blood pressure due to glucocorticoid deficiency. There are several possible mechanisms by which hypopituitarism can result in hyponatremia, including decreased free-water clearance by hypothyroidism, direct syndrome of inappropriate antidiuretic hormone (ADH) hypersecretion, decreased free-water clearance by glucocorticoid deficiency (independent of ADH). Serum potassium levels, however, will not change due to Sheehan’s syndrome. This is because potassium levels are primarily regulated independently from the pituitary gland (the renin-angiotensin-aldosterone system begins in the kidney). Causes
In the developed world Sheehan’s Syndrome is a rare complication of pregnancy, usually manifesting after excessive blood loss after delivery. The presence of disseminated intravascular coagulation (i.e., in amniotic fluid embolism or HELLP syndrome) also appears to be a factor in its development.
Treatment
Lifelong hormone replacement therapy for the hormones that are missing. This may involve treatment with glucocorticoids. After hormone profiling, treatment with cortisol, ACTH, thyroid hormones, gonadotropins, and prolactin as seen in cases of hypopituitarism may occur. Epidemiology
In a study of 1,034 symptomatic adults, Sheehan’s syndrome was found to be the sixth-most frequent etiology of growth hormone deficiency, being responsible for 3.1% of cases (versus 53.9% due to a pituitary tumor).Sheehan syndrome is more prevalent in developing countries than developed countries. Additionally, it was found that the majority of women who experienced Sheehan syndrome gave birth at home rather than in a hospital. History
The specific association with postpartum shock or hemorrhage was described in 1937 by the British pathologist Harold Leeming Sheehan (1900–1988). The initial distinction was made in the research article “Post-Partum Necrosis of the Anterior Pituitary”. In his research, Dr. Sheehan reviewed (through autopsy) the effects of pituitary necrosis on 12 cases of patient’s that experienced postpartum necrosis. He observed cases where lesions and death occurred during or after pregnancy, as well as cases where death occurred in the late stage of necrosis (years later). This started the initial distinction of Sheehan’s syndrome from Simmonds’ disease (also known as hypopituitarism). Dr. Sheehan noted that significant features of these patient cases was hemorrhaging, which in his experience was most commonly caused by either: placenta Previa (low placenta), uterine rupture, cervical or uterine tears, post-partum atony, or retained placenta.