{"id":4422323,"date":"2025-01-11T13:55:18","date_gmt":"2025-01-11T19:55:18","guid":{"rendered":"https:\/\/myendoconsult.com\/learn\/topics\/sheehan-syndrome\/"},"modified":"2025-01-13T06:45:56","modified_gmt":"2025-01-13T12:45:56","slug":"sheehan-syndrome","status":"publish","type":"oen_topic","link":"https:\/\/myendoconsult.com\/learn\/topics\/sheehan-syndrome\/","title":{"rendered":"Sheehan Syndrome"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">POSTPARTUM PITUITARY INFARCTION (SHEEHAN SYNDROME)<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Overview and Pathophysiology<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Definition<\/strong>: Sheehan syndrome is postpartum necrosis of the pituitary gland secondary to severe blood loss and hypovolemia during or after childbirth.<\/li>\n\n\n\n<li><strong>Mechanism<\/strong>:\n<ol class=\"wp-block-list\">\n<li><strong>Pituitary Enlargement in Pregnancy<\/strong>: Primarily due to hyperplasia of lactotroph cells.<\/li>\n\n\n\n<li><strong>Vulnerability to Blood Pressure Changes<\/strong>: The pituitary relies heavily on its portal venous system (relatively low-pressure).<\/li>\n\n\n\n<li><strong>Ischemic Infarction<\/strong>:\n<ul class=\"wp-block-list\">\n<li>Historically described as vasospasm of infundibular arteries drained by the portal system.<\/li>\n\n\n\n<li>May also involve thrombosis or vascular compression, leading to infarction of the adenohypophysis.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Infarcted Areas<\/strong>: Undergo necrosis, eventually replaced by fibrotic scar tissue.<\/li>\n<\/ol>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Extent of Infarction<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Typical Involvement<\/strong>:\n<ul class=\"wp-block-list\">\n<li>Often ~97% of the anterior lobe is affected, but the pars tuberalis and part of the superior surface may be spared.<\/li>\n\n\n\n<li>Alternatively, a small region at the lateral pole or a thin peripheral rim of tissue adjacent to the sellar wall might remain viable, nourished by a separate capsular blood supply.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Functional Threshold<\/strong>:\n<ul class=\"wp-block-list\">\n<li><strong>>75% loss<\/strong> of adenohypophyseal cells \u2192 partial pituitary failure.<\/li>\n\n\n\n<li><strong>>90% loss<\/strong> \u2192 complete pituitary failure.<\/li>\n\n\n\n<li><strong>>30% preserved<\/strong> \u2192 may prevent immediate severe hypopituitarism.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Clinical Presentation<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Acute Onset<\/strong>\n<ul class=\"wp-block-list\">\n<li>Severe hypovolemic shock (from hemorrhage) compounded by acute glucocorticoid deficiency can be life-threatening.<\/li>\n\n\n\n<li>Immediate pituitary failure symptoms (e.g., shock, <a href=\"https:\/\/myendoconsult.com\/learn\/primary-adrenal-insufficiency-sick-day-rules\/\"  data-wpil-monitor-id=\"96\">adrenal insufficiency<\/a>).<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Gradual Onset<\/strong>\n<ul class=\"wp-block-list\">\n<li>Inability to lactate (due to prolactin deficiency) is often the <strong>first recognized sign postpartum<\/strong>.<\/li>\n\n\n\n<li>Amenorrhea or oligomenorrhea, loss of axillary\/pubic hair.<\/li>\n\n\n\n<li>Lethargy, anorexia, weight loss, and other signs of anterior pituitary hormone deficiencies (TSH, ACTH, LH\/FSH, GH).<\/li>\n\n\n\n<li><a href=\"https:\/\/myendoconsult.com\/learn\/topics\/diabetes-insipidus\/\"  data-wpil-monitor-id=\"95\">Diabetes insipidus<\/a> (posterior pituitary failure) is <strong>rare<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<h3 class=\"wp-block-heading\">Diagnosis<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Clinical Suspicion<\/strong>:\n<ul class=\"wp-block-list\">\n<li>History of severe postpartum hemorrhage requiring transfusion.<\/li>\n\n\n\n<li>Postpartum failure to lactate, persistent amenorrhea, or secondary sexual hair loss.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Laboratory Tests<\/strong>:\n<ul class=\"wp-block-list\">\n<li><strong>Morning (8 AM) Cortisol<\/strong><\/li>\n\n\n\n<li><strong>Free Thyroxine (T4)<\/strong><\/li>\n\n\n\n<li><strong>Prolactin<\/strong> (often low in Sheehan syndrome)<\/li>\n\n\n\n<li><strong>Estradiol<\/strong><\/li>\n\n\n\n<li><strong>Insulinlike Growth Factor 1 (IGF-1)<\/strong><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Imaging (MRI)<\/strong>:\n<ul class=\"wp-block-list\">\n<li>Early stages: Enlarged pituitary with ischemic infarct.<\/li>\n\n\n\n<li>Over months: Gradual shrinkage \u2192 atrophy \u2192 \u201cempty sella\u201d appearance.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Treatment and Prognosis<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Lifelong Target Gland Hormone Replacement<\/strong>:\n<ol class=\"wp-block-list\">\n<li>Glucocorticoids (for ACTH deficiency)<\/li>\n\n\n\n<li>Levothyroxine (for TSH deficiency)<\/li>\n\n\n\n<li>Sex steroids (for LH\/FSH deficiency) if fertility is not immediately desired; gonadotropins for fertility.<\/li>\n\n\n\n<li>GH replacement if needed (particularly in children or if adult GH deficiency is symptomatic).<\/li>\n<\/ol>\n<\/li>\n\n\n\n<li><strong>Acute Management<\/strong>: Prompt recognition and <a href=\"https:\/\/myendoconsult.com\/learn\/courses\/diagnosis-and-treatment-of-primary-adrenal-insufficiency\/\"  data-wpil-monitor-id=\"97\">treatment of adrenal insufficiency<\/a> is critical to prevent fatal adrenal crisis.<\/li>\n\n\n\n<li><strong>Long-Term Outlook<\/strong>: With appropriate hormone replacement, patients can maintain a good quality of life.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>POSTPARTUM PITUITARY INFARCTION (SHEEHAN SYNDROME) Overview and Pathophysiology Extent of Infarction Clinical Presentation Diagnosis Treatment and Prognosis<\/p>\n","protected":false},"featured_media":0,"template":"","oen_topic_chapter":[682],"class_list":["post-4422323","oen_topic","type-oen_topic","status-publish","hentry","oen_topic_chapter-pituitary-gland","post-wrapper","thrv_wrapper"],"_links":{"self":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422323","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic"}],"about":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/types\/oen_topic"}],"version-history":[{"count":3,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422323\/revisions"}],"predecessor-version":[{"id":4422327,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422323\/revisions\/4422327"}],"wp:attachment":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/media?parent=4422323"}],"wp:term":[{"taxonomy":"oen_topic_chapter","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic_chapter?post=4422323"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}