Sheehan's Syndrome

Sheehan's Syndrome

Sheehan's syndrome is damage to the pituitary gland due to complications during childbirth. The condition is triggered by heavy bleeding or very low blood pressure during or after delivery.

The pituitary gland or hypophysis is a small gland located under the brain. The function of this gland is to produce hormones that control growth, production of thyroid hormones and cortisol hormones, milk production, menstrual cycles, and reproduction.

If the function of the pituitary gland is disturbed, then the production of pituitary hormones will decrease. This can give rise to a group of symptoms called hypopituitarism . This collection of symptoms is called Sheehan's syndrome if it occurs after childbirth.

Causes of Sheehan's Syndrome

During pregnancy, the size of the pituitary gland will increase, especially in the weeks before delivery. Therefore, at this time, the pituitary gland will need more nutrients and oxygen from the blood supply.

Sheehan's syndrome occurs when childbirth is accompanied by heavy bleeding or very low blood pressure. This condition can cause damage to the pituitary gland tissue, because this gland actually needs more blood flow. As a result, this gland is unable to function normally.

Risk Factors for Sheehan's Syndrome

Any condition that increases the risk of heavy bleeding or low blood pressure during pregnancy in itself increases the risk of developing Sheehan's syndrome. These conditions or factors are:

  • Abruption of the placenta , which is the detachment of the placenta from the uterine wall before the baby is born
  • Placenta previa , which is a condition when part or all of the placenta covers the cervix
  • Giving birth to a child weighing more than 4 kg or giving birth to twins
  • Preeclampsia during pregnancy
  • Delivery with the help of forceps or vacuum

Symptoms of Sheehan's Syndrome

Symptoms of Sheehan's syndrome generally appear slowly over months or even years. However, there are also symptoms that arise suddenly, such as interference with breastfeeding. This depends on how severe the level of damage to the pituitary gland tissue is.

Symptoms that can appear in sufferers of Sheehan's syndrome include:

  • Menstrual disorders, such as amenorrhea or oligomenorrhea
  • Shaved hair does not grow anymore
  • Low blood sugar levels
  • Little or no milk comes out
  • Wrinkles around the eyes and lips
  • Shrinking breasts
  • Weight gain
  • It's easy to get cold
  • Decreased sexual appetite
  • Dry skin
  • The body gets tired easily
  • Decreased mental state
  • Low blood pressure
  • Heart rhythm disturbances or arrhythmias
  • Joint pain

Symptoms of Sheehan's syndrome are often mistaken for other conditions, such as ordinary tiredness, which is normal for new mothers, so it is not diagnosed. In this case, Sheehan's syndrome is usually only detected when an adrenal crisis occurs, which is an emergency condition caused by low levels of the hormone cortisol in the body.

Diagnosis of Sheehan's Syndrome

To diagnose, the doctor will initially ask about the patient's medical history, especially any history of pregnancy complications, postpartum bleeding, breast milk not coming out , or irregular menstruation after giving birth.

After that, to confirm the diagnosis, the doctor will run a blood test to check the levels of hormones produced by the pituitary gland. The doctor will also do a hormone stimulation test, namely by injecting hormones and seeing the response of the pituitary gland through several blood tests.

If needed, the doctor will also run imaging tests, such as a CT scan or MRI . This test aims to see the size of the pituitary gland and rule out the possibility that the complaint is caused by another condition, such as a pituitary tumor .

Treatment of Sheehan's Syndrome

Treatment of Sheehan's syndrome is done with hormone replacement therapy . Some of the hormone replacements that doctors can give are:

  • Corticosteroids , such as hydrocortisone and prednisone, to replace adrenal hormones that are not being produced, due to adrenocorticotropic hormone (ACTH) deficiency
  • Levothyroxine, to treat thyroid hormone deficiency ( hypothyroidism ), due to low levels of thyroid-stimulating hormone (TSH)
  • Estrogen (for patients who have undergone surgical removal of the uterus) or a combination of estrogen and progesterone (for patients who still have a uterus), to restore normal menstrual cycles
  • Growth hormone, to lower cholesterol levels, maintain bone mass, normalize the ratio of muscle and body fat, and improve the overall quality of life of sufferers

Sheehan's Syndrome Complications

Pituitary hormones play an important role in the body's metabolic functions. Therefore, disturbances in the production of pituitary hormones can cause complications in the form of:

  • Low blood pressure
  • Losing weight for no reason
  • Menstrual cycle disorders
  • Adrenal crisis, which is a medical emergency that can cause shock, loss of consciousness, and even coma
  • Empty sella syndrome

Prevention of Sheehan's Syndrome

The risk of Sheehan's syndrome can be reduced by taking steps to prevent bleeding and low blood pressure during labour. This can be achieved one of them by carrying out routine pregnancy checks and preparing for the delivery process properly.

Back to blog