Sheehan syndrome; What you need to know!

Sheehan syndrome, also known as postpartum pituitary necrosis is a condition that occurs as a result of severe bleeding during childbirth. Consequently, there is inadequate blood supply to the pituitary gland during childbirth. It can have serious implications, although it is a rare complication of childbirth and is more commonly observed in developing countries.

To simplify things ,during childbirth, significant blood loss can occur, leading to a drop in blood pressure. In some cases, there is a severe drop in blood pressure. This causes the blood supply to the pituitary gland to be compromised. As a result, the pituitary gland in the brain may not receive enough oxygen and nutrients. What happens thereafter, is a partial or complete destruction of the gland.

Sheehan syndrome causes a variety of hormonal deficiencies. Because, the pituitary gland is responsible for regulating the function of other hormone-producing glands in the body. However, the symptoms and severity of the syndrome can vary depending on which hormones are affected.

Symptoms of Sheehan syndrome

Here are some common symptoms associated with Sheehan syndrome:

1. Failure to lactate: This is the earliest symptom. The woman complains of an inability to produce breast milk after childbirth. This is due to the damage to the pituitary gland, which impairs the secretion of prolactin, the hormone responsible for milk production.

2.Irregular or absent menstrual periods: As Sheehan syndrome disrupts the normal hormonal balance in the body, there are symptoms of menstrual irregularities such as missed periods or the complete absence of menstruation (amenorrhea).

3.Fatigue and weakness: Pituitary hormone deficiencies can result in chronic fatigue and generalized weakness. The affected individual may feel tired and exhausted even with minimal physical or mental exertion.

4.Cold intolerance: A decreased level of thyroid-stimulating hormone (TSH) production due to pituitary damage can lead to an underactive thyroid gland (hypothyroidism). This may cause symptoms such as sensitivity to cold temperatures, weight gain, and sluggishness.

5.Low blood pressure: The pituitary gland produces another hormone, the adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce cortisol.

Cortisol is a hormone that helps regulate blood pressure. In Sheehan syndrome, inadequate production of ACTH can result in low blood pressure (hypotension).

6.Hair loss and dry skin: Sheehan syndrome is linked with hypothyroidism and adrenal insufficiency, that can cause dry skin, brittle nails, and hair loss.

7.Weight gain: Hormonal imbalances can affect metabolism, leading to weight gain, especially in the abdominal area.

8.Loss of libido and sexual dysfunction: Pituitary damage can impact the production of hormones like luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which play a role in sexual function. As a result, women with Sheehan syndrome may experience a decreased sex drive and other sexual dysfunctions.

Other complications of Sheehan syndrome

9. Short stature, decreased muscle mass : growth hormone deficiency can lead to short stature, decreased muscle mass, increased body fat, and reduced exercise capacity. It may also affect bone density and increase the risk of developing osteoporosis.

10. Psychiatric symptoms: Hormonal imbalances can also contribute to psychological symptoms such as depression, anxiety, mood swings, and cognitive difficulties.

Diagnosis of Sheehan syndrome

The diagnosis of Sheehan’s syndrome typically involves a combination of medical history, physical examination, and various laboratory tests. Here are some steps that may be involved :

1. Medical history: Your doctor will ask about your symptoms and any history of childbirth-related complications, such as postpartum hemorrhage.

2. Physical examination: He /She will then perform a physical examination to check for signs and symptoms associated with hormonal deficiencies, such as low blood pressure, weight loss, decreased breast milk production, and changes in skin pigmentation.

3.Hormone testing: Blood tests may be conducted to measure the levels of different hormones produced by the pituitary gland, including thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), growth hormone (GH), prolactin, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Abnormal levels of these hormones are indicative.

4.Dynamic function tests: In some cases, your doctor may perform dynamic function tests to assess the pituitary gland’s ability to respond to specific stimuli. For example, an insulin tolerance test or glucagon stimulation test may be performed.

Treatment option

The treatment of Sheehan’s syndrome involves hormone replacement therapy to address the specific hormone deficiencies.

The Nigerian perspective

According to a study done by ncbi, post partum haemorrhage accounted for 1.68% of total maternal mortality post vaginal deliveries in the period of study. Primary post partum haemorrhage (PPPH) constituted 67.87% while secondary postpartum haemorrhage constituted 32.14%.

An indirect deduction from this data is that there is a high risk of Sheehan syndrome developing amongst Nigerian women. Besides, there being a high probability of undiagnosed cases of the syndrome because of the poor health seeking habits of Nigerians.

Hence let us be highly vigilant. So, we can be aware of even subtle changes in health status.

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