Sheehan's syndrome

 Sheehan's syndrome, also known as postpartum pituitary gland necrosis, occurs when the pituitary gland is damaged due to significant blood loss and hypovolemic shock usually during or after childbirth leading to decreased functioning of the pituitary gland , hypopituitarism. The pituitary gland is an endocrine organ, meaning it produces certain hormones and is involved in the regulation of various other hormones.

Fig: Nuclear magnetic resonance imaging manifestations of the patient indicate pituitary atrophy (Organ bold arrow): (A) sagital T1 weighted , (B) coronal T2 weighted , (C) sagital T1-weighted postcontrast,  and (D) coronal T1-weighted coronal.

Causes: Severe bleeding during childbirth can cause tissue in the pituitary gland to die. This gland does not work properly as a result.

The pituitary gland is at the base of the brain. It makes hormones that stimulate growth, production of breast milk, reproductive functions, the thyroid, and the adrenal glands. A lack of these hormones can lead to a variety of symptoms. Conditions that increase the risk of bleeding during childbirth and Sheehan syndrome include multiple pregnancy and problems with the placenta. The placenta is the organ that develops during pregnancy to feed the fetus.

Symptoms: 

.Inability to breastfeed

.Fatigue

.Lack of menstrual bleeding

.Loss of pubic and armpit hair

.Low blood pressure

Diagnosis:

Hormonal assays measure the levels of these horomones which include but are not limited to T4, TSH, Estrogen , gonadotropin , cortisol and ACTH . It might be difficult to detect damage to these hormone pathways if hormone levels are at the borderline of the abnormal range.

Treatment:

The mainstay of treatment is hormone replacement therapy for the hormones that are missing. Treatment plans and dosages should be individualized by an endocrinologist. Glucocorticoids may be administered to address or prevent an adrenal crisis, a potential serious complication of Sheehan's syndrome. Hormone replacement is vital in reducing the morbidity and mortality of this syndrome.