Sheehan’s Syndrome

Sheehan’s syndrome is a rare complication of post-partum haemorrhage, where the drop in circulating blood volume leads to avascular necrosis of the pituitary gland. Low blood pressure and reduced perfusion of the pituitary gland leads to ischaemia in the cells of the pituitary, and cell death.

Sheehan’s syndrome only affects the anterior pituitary gland. Therefore, hormones produced by the posterior pituitary are spared.

 

Blood Supply

The anterior pituitary gets its blood supply from a low-pressure system called the hypothalamo-hypophyseal portal system. This system is susceptible to rapid drops in blood pressure.

The posterior pituitary gets a good blood supply from various arteries, and is therefore not susceptible to ischaemia when there is a drop in blood pressure.

 

Hormones

The anterior pituitary releases:

  • Thyroid-stimulating hormone (TSH)
  • Adrenocorticotropic hormone (ACTH)
  • Follicle-stimulating hormone (FSH)
  • Luteinising hormone (LH)
  • Growth hormone (GH)
  • Prolactin

 

The posterior pituitary releases (not affected by Sheehan’s syndrome):

  • Oxytocin
  • Antidiuretic hormone (ADH)

 

Presentation

Sheehan’s syndrome causes a lack of the hormones produced by the anterior pituitary, leading to signs and symptoms of:

  • Reduced lactation (lack of prolactin)
  • Amenorrhea (lack of LH and FSH)
  • Adrenal insufficiency and adrenal crisis, caused by low cortisol (lack of ACTH)
  • Hypothyroidism with low thyroid hormones (lack of TSH)

 

Management

Sheehan’s syndrome will be managed under the guidance of a specialist endocrinologist. It will involve replacement for the missing hormones:

  • Oestrogen and progesterone as hormone replacement therapy for the female sex hormones (until menopause)
  • Hydrocortisone for adrenal insufficiency
  • Levothyroxine for hypothyroidism
  • Growth hormone

 

Last updated September 2020
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