Sheehan's Syndrome
Sheehan's Syndrome
Sheehan's Syndrome, also known as postpartum hypopituitarism or postpartum pituitary insufficiency, is a rare condition that can occur following severe blood loss or very low blood pressure during or immediately after childbirth.
What is Sheehan's Syndrome?
During severe bleeding, the blood supply and oxygen reaching the pituitary gland can become significantly reduced. Because the pituitary gland requires a continuous blood supply to function, severe oxygen deprivation can damage or destroy pituitary tissue. This can result in hypopituitarism, where the pituitary gland is unable to produce enough of one or more important hormones.
Sheehan's Syndrome most commonly affects the anterior (front) part of the pituitary gland. Depending on the extent of the damage, it can affect the production of several hormones, including:
ACTH – stimulates the adrenal glands to produce cortisol.
TSH – stimulates the thyroid gland to produce thyroid hormones.
LH and FSH – regulate the menstrual cycle, ovulation and reproductive function.
Prolactin – is important for breast milk production.
Growth hormone (GH) – plays an important role in growth, metabolism and overall wellbeing.
The severity of hormone deficiencies can vary considerably from person to person. Symptoms may develop gradually and, in some cases, may not become apparent until months or even years after childbirth.
Sheehan's Syndrome is not hereditary and does not pass from a parent to their children.
Who is at risk?
Sheehan's Syndrome is associated with significant obstetric haemorrhage (severe bleeding) and/or very low blood pressure during childbirth.
Factors that may increase the risk of severe bleeding include:
Multiple pregnancy, such as twins or triplets
Problems affecting the placenta
Complications during labour or delivery
Sheehan's Syndrome has become less common in countries where access to modern obstetric and emergency care is widely available. However, it remains an important cause of hypopituitarism in some parts of the world.
Signs and symptoms
The symptoms of Sheehan's Syndrome can be subtle and may not appear immediately after childbirth. Some people may have only a few symptoms, while others may develop several hormone deficiencies.
Possible symptoms include:
Difficulty breastfeeding or an inability to produce breast milk
Reduced or absent menstrual periods
Irregular periods
Reduced body hair, particularly in the underarm and pubic areas
Unexplained weight gain or difficulty losing weight
Persistent tiredness or fatigue
Dizziness or low blood pressure
Reduced energy and general wellbeing
Symptoms associated with low thyroid or cortisol levels
Because symptoms can develop gradually, Sheehan's Syndrome may sometimes go unrecognised for a long time.
How is Sheehan's Syndrome diagnosed?
Diagnosis usually begins with a detailed medical history, including what happened during pregnancy and childbirth. Your healthcare professional may ask about significant blood loss, low blood pressure, difficulties with breastfeeding and changes to your menstrual cycle following childbirth.
Blood tests are used to measure hormone levels and assess whether the pituitary gland is producing sufficient amounts of the hormones required by the body.
In some cases, dynamic hormone testing may be needed. These tests assess how the pituitary and other hormone-producing glands respond when stimulated.
An MRI scan of the pituitary region may also be performed. This can help assess the appearance and size of the pituitary gland and rule out other possible causes of hypopituitarism, such as a pituitary tumour. A CT scan may occasionally be used when an MRI is not appropriate.
Treatment
There is currently no treatment that can restore damaged pituitary tissue. Treatment focuses on replacing the hormones that the body is no longer producing adequately.
Depending on the individual hormone deficiencies, treatment may include:
Cortisol replacement, usually with hydrocortisone or another glucocorticoid
Thyroid hormone replacement, usually with levothyroxine
Oestrogen replacement, which may be provided in several forms, including tablets, patches or gels
Growth hormone replacement, where appropriate, usually given as a small daily injection
Other hormone treatment where required, depending on individual circumstances and reproductive needs
Treatment is individualised and should be regularly reviewed by an endocrinology team.
Living with Sheehan's Syndrome
For many people, hormone replacement treatment can effectively manage the condition and allow them to lead a full and active life.
When cortisol replacement is required, it is particularly important to understand adrenal insufficiency and steroid emergency management. This includes knowing how to follow your healthcare team's Sick Day Rules when you are unwell and how to use an emergency hydrocortisone injection if required.
People taking steroid replacement should also consider carrying medical identification, such as an emergency steroid card, medical alert jewellery or an appropriate medical ID stored on their phone.
Regular follow-up with an endocrinologist or specialist healthcare team is important to ensure hormone replacement remains appropriate and that any changes in symptoms are assessed.
Support and further information
If you have been diagnosed with Sheehan's Syndrome, or believe you may have symptoms following significant blood loss during childbirth, speak with your GP or endocrinology team.
Maternal Pituitary Support provides information and support for people affected by Sheehan's Syndrome and other maternal pituitary conditions.
Pituitary Ireland is also here to provide information, support and connection for people living with pituitary conditions and their families.