A condition caused by severe blood loss that occurs during childbirth is called Sheehan syndrome. It may also cause damage to the pituitary gland. This gland produces vital hormones that the body needs to function properly. Usually, this syndrome is treated with medicines.
In other words, severe blood loss reduces the amount of oxygen the pituitary gland gets. As a result, some tissue dies. The pituitary gland is located at the base of the brain, and it often grows during pregnancy, which makes it more susceptible to injuries. It is important to know that damage to this gland can have widespread effects on the body because it regulates the production and release of multiple hormones. These hormones are used to regulate the following processes, including muscles, brain, energy, mood, and the reproductive system.
Sometimes, this syndrome is called postpartum hypopituitarism or postpartum pituitary necrosis.
In general, this syndrome occurs very rarely and affects about 5 out of every 100,000 pregnant women. Sheehan syndrome is more common in regions where adequate emergency care is not available.
How Does Sheehan Syndrome Affect The Body?
Damage to the pituitary gland may negatively affect the whole body. Check below some important hormones that this gland regulates:
- Adrenocorticotropic hormone (ACTH) – This hormone stimulates the production of the primary stress hormone called Cortisol. It helps maintain blood pressure and blood sugar levels.
- Thyroid-stimulating hormone (TSH) – It also stimulates the thyroid gland to produce and release hormones that regulate energy, the nervous system, and metabolism.
- Growth hormone (GH) – This hormone helps keep your bone density, muscle mass, and fat distribution.
- Follicle-stimulating hormone (FSH) – FSH stimulates Estrogen production in the ovaries. It also causes an egg to mature each month.
- Luteinizing hormone (LH) – This hormone stimulates ovulation.
- Prolactin (PRL) – This hormone stimulates lactation during pregnancy. Therefore, this allows you to breastfeed.
Symptoms
While some symptoms occur suddenly, others appear gradually over time (a few months or even several years). Check below some symptoms that people with Sheehan syndrome often experience:
- Inability to breastfeed or milk never comes after birth
- Amenorrhea – Irregular or lack of menstrual periods.
- Vaginal atrophy – This causes vaginal walls to become thin and vaginal dryness. It may also make your sexual intercourse painful.
- Breast shrinkage
- Reduced sex drive
- Fatigue (extreme tiredness)
- Hypotension (low blood pressure)
- Low energy
- Difficulty focusing or concentrating
- Dry skin
Sometimes, symptoms appear when you experience a stressful life event (including surgery, an infection, injury, or others). Thus, the symptoms begin to appear because you do not have enough stress hormone to respond to stressors (Cortisol). It is called an adrenal crisis, and it is a medical emergency that requires immediate treatment.
Causes
This syndrome occurs due to severe blood loss during childbirth. It causes damage to the pituitary gland. Normally, the pituitary gland grows during pregnancy and can reach even normal size. Therefore, it makes it vulnerable to reduced oxygen-rich blood. Extreme blood loss or severe drop in blood pressure during delivery may lead to damage to the pituitary gland.
Once this gland is damaged, it cannot function properly and produce enough hormones needed to regulate multiple processes in the body. As a result, reduced or a lack of pituitary gland hormones negatively affects some processes in the body, including the reproductive system, nervous system, and others.
Furthermore, this is not a genetic disorder that you can inherit from biological parents.
Risk Factors
There are some factors that put you at increased risk of severe blood loss and a sudden drop in blood pressure during childbirth. Check below some examples:
- Placenta previa or abruption
- Preeclampsia
- Assisted delivery (forceps or vacuum extraction)
- Giving birth to a large baby or more than one baby (including twins, triplets, or more)
What Are The Potential Complications of Sheehan Syndrome?
People who develop this syndrome may also experience some complications, especially if they do not get immediate treatment. For example:
- Adrenal crisis
- Irregular menstrual periods
- Difficulty conceiving another pregnancy
- Unusual weight or muscle mass loss
- Hypotension (low blood pressure)
- Inability to breastfeed
- Hormonal imbalances (including growth hormone, gonadotropins, thyroid-stimulating hormone, and others)
- Cardiovascular problems (including endothelial dysfunction)
- Diabetes insipidus
This document does not contain a full list of Sheehan syndrome complications. However, you can consult with your healthcare professional about ways to reduce the risk or even prevent previous complications.
How to Prevent Sheehan Syndrome?
Unfortunately, there is no way to prevent this condition, but doctors usually can manage blood loss and blood pressure during labor and delivery. In addition, healthcare professionals usually can prevent pregnancy complications (including severe blood loss), which significantly reduces the risk of developing this syndrome.
Diagnosis
Usually, the diagnosis of this syndrome begins with a physical examination. Thereafter, doctors can evaluate your medical history and ask some questions about the symptoms. However, to confirm the condition, doctors may perform the following tests. Examples include:
- Blood tests – These tests are often done to check the hormone levels related to the pituitary gland function.
- Imaging tests – The following imaging tests are often performed by doctors to rule out other conditions that cause similar symptoms. In most cases, doctors perform MRI (magnetic resonance imaging) scans or CT (computed tomography) scans.
Sometimes, doctors may check hormone levels directly or by using certain stimulants. For example:
- Testing hormone levels – Physicians may check hormones such as ACTH, Estradiol, Cortisol, IGF-1, FSH, LH, and others.
- Stimulation tests – During this test, doctors will give you an injection or medicine that stimulates the production of some pituitary hormones. Therefore, they can assess how the pituitary gland responds.
Treatment
In most cases, people with Sheehan syndrome should take hormones for the rest of their lives. The most common treatment prescribed by doctors is hormone therapy. Check below some hormones:
- Sex hormones – You may need to take Estrogen and Progesterone to regulate menstrual periods and premature menopausal symptoms. Moreover, your doctor may also recommend LH and FSH to help with ovulation.
- Corticosteroids – Commonly, physicians prescribe Hydrocortisone and Prednisone to make up for Adrenocorticotropic hormone (ACTH) deficiency. However, the dosages should be adjusted regularly, especially if you are going through high-stress situations (such as surgery).
- Thyroid hormones – People with Sheehan syndrome often take Levothyroxine to treat TSH deficiency.
- Growth hormones – Taking these hormones may help with bone density and muscle mass.
Mostly, people with Sheehan syndrome are referred to an endocrinologist. It helps with regular checkups and makes sure your hormone levels are within a healthy range.
Frequently Asked Questions
What can I expect if I have Sheehan syndrome?
In general, most people with this syndrome who get treatment have a good prognosis. It means they do not experience serious complications and have multiple successful pregnancies after diagnosis.
What is the life expectancy of someone with hypopituitarism?
With treatment, hypopituitarism does not affect your lifespan. However, people who develop this disorder require treatment for the rest of their lives. For more details, discuss it with your doctor.
When should I go to the emergency room?
Immediately call 911 or go to the nearest emergency room (ER) if you experience any of the following symptoms. Examples include:
- Weakness
- High fever
- Lightheadedness
- Pain in the back, abdomen, or chest
- Nausea
- Vomiting
- Confusion
- Loss of consciousness
Ask your healthcare provider if you have additional questions.
