World Library  
Flag as Inappropriate
Email this Article

Sheehan's syndrome

Article Id: WHEBN0000862681
Reproduction Date:

Title: Sheehan's syndrome  
Author: World Heritage Encyclopedia
Language: English
Subject: Sheehan (disambiguation), Postpartum period, MODY 3, MODY 4, Sertoli cell-only syndrome
Publisher: World Heritage Encyclopedia

Sheehan's syndrome

Sheehan syndrome
Classification and external resources
ICD-10 E23.0
ICD-9 253.2
DiseasesDB 11998
MedlinePlus 001175
eMedicine med/1914
MeSH D007018

Sheehan syndrome, also known as Simmond syndrome, postpartum hypopituitarism or postpartum pituitary gland necrosis, is hypopituitarism (decreased functioning of the pituitary gland), caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth.[1]

Signs and symptoms

Most common initial symptoms of Sheehan's syndrome are agalactorrhea (absence of lactation) and/or difficulties with lactation.[2] Many women also report amenorrhea or oligomenorrhea after delivery.[2] In some cases, a woman with Sheehan syndrome might be relatively asymptomatic, and the diagnosis is not made until years later, with features of hypopituitarism.[2] Such features include secondary hypothyroidism with tiredness, intolerance to cold, constipation, weight gain, hair loss and slowed thinking, as well as a slowed heart rate and low blood pressure. Another such feature is secondary adrenal insufficiency, which, in the rather chronic case is similar to Addison's disease with symptoms including fatigue, weight loss, hypoglycemia (low blood sugar levels), anemia and hyponatremia (low sodium levels). Such a woman may, however, become acutely exacerbated when her body is stressed by, for example, a severe infection or surgery years after her delivery, a condition equivalent with an Addisonian crisis.[2] The symptoms of adrenal crisis should be treated immediately and can be life-threatening [3] Gonadotropin deficiency will often cause amenorrhea, oligomenorrhea, hot flushes, or decreased libido.[2] Growth hormone deficiency causes many vague symptoms including fatigue and decreased muscle mass.[2]

Uncommonly, Sheehan syndrome may also appear acutely after delivery, mainly by hyponatremia.[2] There are several possible mechanisms by which hypopituitarism can result in hyponatremia, including decreased free-water clearance by hypothyroidism, direct syndrome of inappropriate antidiuretic hormone (ADH) hypersecretion, decreased free-water clearance by glucocorticoid deficiency (independent of ADH).[2] The potassium level in these situations is normal, because adrenal production of aldosterone is not dependent on the pituitary.[2] There have also been cases with acute hypoglycemia.[4]

The order of frequency of hormone loss has generally been found to be growth hormone, gonadotropins (FSH, LH), adrenocorticotrophin (ACTH) and thyroid stimulating hormone (TSH).[5][6]


It is a rare complication of pregnancy, usually occurring after excessive blood loss. The presence of disseminated intravascular coagulation (i.e., in amniotic fluid embolism or HELLP syndrome) also appears to be a factor in its development.


Hypertrophy and hyperplasia of lactotrophs during pregnancy results in the enlargement of the anterior pituitary, without a corresponding increase in blood supply.

Secondly, the anterior pituitary is supplied by a low pressure portal venous system.[7]

These vulnerabilities, when affected by major hemorrhage or hypotension during the peripartum period, can result in ischaemia of the affected pituitary regions leading to necrosis.

The posterior pituitary is usually not affected due to its direct arterial supply.

A 1995 study found that 56.2% of patients with Sheehan’s syndrome experienced a loss of all pituitary hormones (with the remaining 43.8% having selective pituitary insufficiency). However, likely because the growth hormone-secreting cells are located at the periphery of the pituitary (and are therefore most likely to be affected by ischemia), all the patients had growth hormone deficiency.[8]


In a study of 1,034 symptomatic adults, Sheehan syndrome was found to be the sixth most frequent etiology of growth hormone deficiency, being responsible for 3.1% of cases (versus 53.9% due to a pituitary tumor).[9]


The specific association with postpartum shock or haemorrhage was described in 1937 by the British pathologist Harold Leeming Sheehan (1900–1988),[10] whereas Simmond's disease occurs in either sex due to causes unrelated to pregnancy.[11]


  1. ^ First Aid for the Obstetrics and Gynecology Clerkship, p. 226, PITUITARY (HYPOESTROGENIC AMENORRHEA)
  2. ^ a b c d e f g h i Schrager S, Sabo L (2001). "Sheehan syndrome: a rare complication of postpartum hemorrhage". J Am Board Fam Pract 14 (5): 389–91.  
  3. ^
  4. ^ Bunch TJ, Dunn WF, Basu A, Gosman RI (October 2002). "Hyponatremia and hypoglycemia in acute Sheehan's syndrome". Gynecol. Endocrinol. 16 (5): 419–23.  
  5. ^ Rabkin MT & Frantz AG. Hypopituitarism: a study of growth hormone and other endocrine functions. Annals of Internal Medicine 1966 64 1197–1207.
  6. ^ Kelestimur F, Jonsson P, Molvalilar S, Gomez JM, Auernhammer CJ, Colak R, Koltowska-Häggström M, Goth MI. Sheehan's syndrome: baseline characteristics and effect of 2 years of growth hormone replacement therapy in 91 patients in KIMS - Pfizer International Metabolic Database. Eur J Endocrinol. 2005 Apr;152(4):581-7.
  7. ^ under heading Sheehan's syndrome
  8. ^ Keleştimur F. GH deficiency and the degree of hypopituitarism. Clinical Endocrinology 1995 42 443–444.
  9. ^ Abs, R; Bengtsson, BA; Hernberg-Stâhl, E; Monson, JP; Tauber, JP; Wilton, P; Wüster, C (June 1999). "GH replacement in 1034 growth hormone deficient hypopituitary adults: demographic and clinical characteristics, dosing and safety.". Clinical endocrinology 50 (6): 703–13.  
  10. ^ H. L. Sheehan. Post-partum necrosis of anterior pituitary. The Journal of Pathology and Bacteriology, Chichester, 1937, 45: 189-214.
  11. ^ Sheehan's syndrome at Who Named It?

External links

  • 617611278 at GPnotebook
  • Pathology at
  • Erciyes University, Turkey
This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.

Copyright © World Library Foundation. All rights reserved. eBooks from Project Gutenberg are sponsored by the World Library Foundation,
a 501c(4) Member's Support Non-Profit Organization, and is NOT affiliated with any governmental agency or department.