Sheehans syndrome: the hidden nemesis

Sheehan’s syndrome is the name given to postpartum hypopituitarism, usually precipitated by massive uterine haemorrhage and hypovolemic shock during or after childbirth resulting into pituitary injury in varying degrees. Most cases are diagnosed very late in life and the first presentation may be a life-threatening situation like shock or cardiorespiratory collape. This hidden nemesis in women compromises their quality of life and may result into mortality if not suspected early. In this article we present 3 patients who presented in the ICU in a state of complete cardio-respiratory collapse and later discharged in full health.

Sheehan's Syndrome: UP-PGH experience from 1974-1984

Nineteen patients with a diagnosis of Sheehan's syndrome or postpartum hypopituitarism admitted to the UP-PGH Medical Center from 1974-1984 were reviewed. The history, signs and symptoms, and results of various laboratory examinations were assessed. Two patients had available postmortem reports Panhypopituitarism (89%) was more common than selective hypopituitarism. LSH producing cells seemed to be spared more often than the others. Hypothyroidism was seen in only 89% of the cases as compared to gonadal failure (100%), and cortisol insufficiency (100%). The pituitary involvement was not limited to the anterior pituitary but may involve the posterior pituitary and or the hypothalamus as suggested by the coexistence of manifestations of diabetes insipidus in 2 of our patients Most common cause of postpartum pituitary necrosis was obstetric hemorrhage but it could also be produced by any condition resulting in severe shock. The syndrome was usually heralded by failure of lactation and amenorrhea associated later with loss of axillary and public hair; genital, uterine, and breast atrophy; symptoms and signs of hypothyroidism and various degrees of adrenocortical insufficiency The different tests designed to show target organ failure did not show positivity in all patients. Among the tests which showed consistent results and thus were most helpful for diagnosis were determinations of: FSH, cortisol and T4 There is excellent prognosis for a productive life of patients with replacement of all target gland hormonal deficiencies. However, failure to diagnose it is disastrous for the patients. Continuation of treatment especially in the presence of stress, i.e. infection should be emphasized by the physicians. Regular follow-up at intervals of all patients with Sheehan's syndrome is necessarily recommended, (Summary)

A Case of Diabetes Insipidus in Patient with Sheehan's Syndrome / 대한내분비학회지

Sheehans syndrome is a known complication of pregnancy, It was described as a syndrome of hypopituitarysm due to acute ischemic necrosis of the anterior pituitary gland secondary to severe postpartum bleeding and shock. The neurophysis is usually preserved. But it can be involved in severe cases manifesting as diabetes insipidus. Because of its rare coexistence with Sheehans syndrome, diabetes insipidus is seldom recognized as a potential postpartum complication. The report describes a patient who developed Sheehans syndrome and diabetes insipidus immediately following delivery. Diabetes insipidus resolved spontaneously after 15 months, while panhypopituitarysm is persistent.