From the Research
Sheehan syndrome can occur as early as a few days after pregnancy, with the median time of presentation after delivery being 7.9 days for adrenal insufficiency, 4 days for diabetes insipidus, 18 days for hypothyroidism, and 9 days for panhypopituitarism, as reported in a case review and literature analysis 1. The condition is caused by ischemic necrosis of the pituitary gland due to severe postpartum hemorrhage, leading to pituitary infarction. The anterior pituitary is particularly vulnerable to this damage because of its increased size during pregnancy and its unique blood supply. Some key points to consider include:
- Early symptoms may include failure to lactate, fatigue, and amenorrhea, while later manifestations can include hypothyroidism, adrenal insufficiency, and gonadotropin deficiency.
- The severity depends on the extent of pituitary damage, with some women experiencing only partial hormone deficiencies while others develop complete panhypopituitarism.
- Prompt recognition and hormone replacement therapy are essential for managing this condition, as highlighted in a recent review of Sheehan syndrome 2.
- A high index of suspicion is necessary to diagnose Sheehan syndrome, especially in women with a history of severe postpartum hemorrhage, as the condition can be easily overlooked and may present with nonspecific symptoms 3. The most recent and highest quality study on this topic is a 2025 review of Sheehan syndrome, which emphasizes the importance of awareness and prompt diagnosis of this condition to prevent increased morbidity and mortality 2.