Sheehan syndrome

Title

Other Names:

Postpartum hypopituitarism; Postpartum panhypopituitarism; Postpartum panhypopituitary syndrome; Postpartum hypopituitarism; Postpartum panhypopituitarism; Postpartum panhypopituitary syndrome; Postpartum pituitary necrosis; Simmond's disease See More

Categories:

Endocrine Diseases

Summary Summary

Sheehan syndrome, or postpartum hypopituitarism, is a rare complication of postpartum hemorrhage. Severe blood loss during or after childbirth can deprive the body of oxygen and seriously damage the pituitary gland. This causes the gland to permanently lose its ability to function properly.^[1]^[2]^[3] Symptoms vary, from failure to lactate, to nonspecific symptoms like fatigue, to adrenal crisis (a life-threatening shortage of the hormone cortisol).^[2]^[3] Treatment involves lifelong hormone replacement therapy.^[1]^[2]^[3]

Last updated: 1/20/2017

Symptoms Symptoms

The pituitary gland produces hormones that stimulate breast milk production, growth, reproductive functions, the thyroid and the adrenal glands. A lack of these hormones can lead to a variety of symptoms.^[1] While some women may experience early symptoms such as difficulty breastfeeding or an inability to breastfeed (breast milk never "comes in"), in most cases the signs and symptoms of Sheehan syndrome develop slowly, sometimes over a period of months or even years.^[2] For many, symptoms become apparent when the body is stressed by infection or surgery some period of time after delivery. This type of stressor can lead to an adrenal crisis.^[2] Symptoms that may develop include:^[1]^[2]^[4]

Fatigue
Joint pain
Hypoglycemia
Dizziness
Amenorrhea (lack of menstrual bleeding)
Oligomenorrhea (infrequent menstrual periods)
Hot flashes
Decreased libido
Loss of pubic and underarm hair
Low blood pressure (hypotension)
Slowed mental functioning
Weight gain
Difficulty staying warm
Irregular heartbeat
Breast shrinkage

Last updated: 1/20/2017

This table lists symptoms that people with this disease may have. For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. This information comes from a database called the Human Phenotype Ontology (HPO) . The HPO collects information on symptoms that have been described in medical resources. The HPO is updated regularly. Use the HPO ID to access more in-depth information about a symptom.

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Medical Terms	Other Names	Learn More: HPO ID
80%-99% of people have these symptoms
Adrenocorticotropic hormone deficiency		0011748
Adrenocorticotropin deficient adrenal insufficiency		0011735
Chronic fatigue	Chronic extreme exhaustion	0012432
Decreased circulating cortisol level	Low blood cortisol level	0008163
Oligomenorrhea	Light or infrequent menstrual periods	0000876
Panhypopituitarism		0000871
Secondary growth hormone deficiency		0008240
30%-79% of people have these symptoms
Abnormal size of pituitary gland		0012504
Amenorrhea	Abnormal absence of menstruation	0000141
Blurred vision		0000622
Breast hypoplasia	Underdeveloped breasts	0003187
Decreased female libido	Decreased female sex drive	0030018
Decreased serum estradiol		0008214
Dry skin		0000958
Dyspareunia		0030016
Gonadotropin deficiency		0008213
Hypoglycemia	Low blood sugar	0001943
Hyposthenuria		0003158
Impotence	Difficulty getting a full erection Difficulty getting an erection [ more ]	0000802
Nausea		0002018
Normochromic anemia		0001895
Orthostatic hypotension	Decrease in blood pressure upon standing up	0001278
Pallor		0000980
Pituitary hypothyroidism	Low thyroid gland function due to abnormal pituitary gland	0008245
Progressive visual field defects		0007987
Reduced circulating prolactin concentration		0008202
Sparse axillary hair	Limited armpit hair Little underarm hair [ more ]	0002215
Sparse pubic hair	Decreased sexual hair	0002225
5%-29% of people have these symptoms
Antinuclear antibody positivity		0003493
Arthralgia	Joint pain	0002829
Bradycardia	Slow heartbeats	0001662
Chills		0025143
Chronic lymphocytic meningitis		0007041
Constipation		0002019
Diplopia	Double vision	0000651
Hashimoto thyroiditis		0000872
Hyponatremia	Low blood sodium levels	0002902
Muscle weakness	Muscular weakness	0001324
Obesity	Having too much body fat	0001513
Palpitations	Missed heart beat Skipped heart beat [ more ]	0001962
Poor appetite	Decreased appetite	0004396
Sensorineural hearing impairment		0000407
Thunderclap headache		0030907
Vertigo	Dizzy spell	0002321
1%-4% of people have these symptoms
Central diabetes insipidus		0000863
Coma		0001259
Psychosis		0000709

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Do you have more information about symptoms of this disease? We want to hear from you.

Last updated: 3/1/2020

Do you have updated information on this disease? We want to hear from you.

Cause Cause

Sheehan syndrome is caused by severe blood loss or extremely low blood pressure during or after childbirth.^[1]^[2] Blood loss at delivery can be particularly damaging to the pituitary gland, which enlarges during pregnancy. This damage destroys the hormone-producing tissue so that the gland cannot function properly.^[1]^[2] Women who are carrying multiples (twins, triplets, etc.) and those who have problems with the placenta have an increased risk for bleeding during childbirth and Sheehan syndrome.^[1]

Last updated: 1/20/2017

Diagnosis Diagnosis

Diagnosis of Sheehan syndrome can be difficult.^[2] The diagnosis is based on clinical evidence of hypopituitarism in a woman with a history of severe postpartum bleeding.^[2]^[3] Blood tests to measure hormone levels and/or hormone stimulation tests can help confirm the diagnosis. An MRI or CT scan of the head should be done to rule out other pituitary problems such as a tumor.^[1]^[2]^[3]

Last updated: 1/21/2017

Treatment Treatment

Treatment involves replacement of the hormones produced by the pituitary gland. The following may be recommended, depending on individual circumstances:^[1]^[2]

Estrogen alone (if the uterus has been removed) or estrogen and progesterone in combination. This should be taken at least until the normal age of menopause.
Levothyroxine to replace thyroid stimulating hormone. This will need to be taken throughout the lifetime.
Corticosteroids to replace adrenal hormones. These must also be taken throughout the lifetime.
Growth hormone may also be suggested, as this may help normalize the body's muscle-to-fat ratio, maintain bone mass, lower cholesterol levels, and/or improve overall quality of life.

The levels of these hormones should be monitored on a regular basis and may need to be adjusted periodically based on factors such as stress level, illness, pregnancy, or changes in weight.^[2]

Last updated: 1/21/2017

Prognosis Prognosis

The outlook with early diagnosis and treatment is excellent. The condition can be life threatening if not treated.^[1]

Last updated: 1/22/2017

Find a Specialist Find a Specialist

If you need medical advice, you can look for doctors or other healthcare professionals who have experience with this disease. You may find these specialists through advocacy organizations, clinical trials, or articles published in medical journals. You may also want to contact a university or tertiary medical center in your area, because these centers tend to see more complex cases and have the latest technology and treatments.

If you can’t find a specialist in your local area, try contacting national or international specialists. They may be able to refer you to someone they know through conferences or research efforts. Some specialists may be willing to consult with you or your local doctors over the phone or by email if you can't travel to them for care.

You can find more tips in our guide, How to Find a Disease Specialist. We also encourage you to explore the rest of this page to find resources that can help you find specialists.

Healthcare Resources

The Pituitary Network Association provides a list of pituitary specialists.

Organizations Organizations

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

Organizations Supporting this Disease

Adrenal Insufficiency United
Toll-free: 1-855-AIUnite (248-6483)
E-mail: contact@aiunited.org
Website: http://aiunited.org/
American Hair Loss Association
23679 Calabasas Road # 682
Calabasas, CA 91301-1502
E-mail: info-ahla@americanhairloss.org
Website: http://americanhairloss.org
Hormone Health Network
Toll-free: 1-800-HORMONE (1-800-467-6663)
E-mail: hormone@endocrine.org
Website: https://www.hormone.org
Pituitary Network Association
P.O. Box 1958
Thousand Oaks, CA 91358
Telephone: +1-805-499-9973
Fax: +1-805-480-0633
E-mail: info@pituitary.org
Website: https://pituitary.org/
The Pituitary Foundation
86 Colston Street
Bristol BS1 5BB
United Kingdom
Telephone: 0117 370 1320
E-mail: helpline@pituitary.org.uk
Website: https://www.pituitary.org.uk/

Do you know of an organization? We want to hear from you.

Learn More Learn More

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

Mayo Clinic has an information page on Sheehan syndrome.
MedlinePlus was designed by the National Library of Medicine to help you research your health questions, and it provides more information about this topic.
The National Organization for Rare Disorders (NORD) has a report for patients and families about this condition. NORD is a patient advocacy organization for individuals with rare diseases and the organizations that serve them.

In-Depth Information

Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
Orphanet is a European reference portal for information on rare diseases and orphan drugs. Access to this database is free of charge.
PubMed is a searchable database of medical literature and lists journal articles that discuss Sheehan syndrome. Click on the link to view a sample search on this topic.

Selected Full-Text Journal Articles

Schrager S, Sabo L. Sheehan Syndrome: A Rare Complication of Postpartum Hemorrhage. J Am Board Fam Med. 2001; 14(5):389-391.

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