From the Research
Sheehan syndrome presents with clinical features resulting from pituitary gland necrosis following severe postpartum hemorrhage, with hallmark symptoms including failure to lactate after delivery and persistent amenorrhea, as well as fatigue, weakness, and cold intolerance due to hypothyroidism, as noted in the most recent study 1. The clinical features of Sheehan syndrome can vary, but common symptoms include:
- Failure to lactate after delivery
- Persistent amenorrhea
- Fatigue, weakness, and cold intolerance due to hypothyroidism
- Hypotension, hypoglycemia, hyponatremia, and decreased pubic and axillary hair from adrenal insufficiency and gonadotropin deficiency
- Decreased libido, vaginal dryness, and loss of secondary sexual characteristics
- Cognitive impairment, depression, and anemia These symptoms occur because the enlarged pituitary gland during pregnancy becomes susceptible to ischemic necrosis during hypotensive episodes associated with severe hemorrhage, leading to varying degrees of anterior pituitary hormone deficiencies, as described in 2, 3, 4, 5. The severity of symptoms varies based on the extent of pituitary damage, with some women developing symptoms immediately after delivery while others present years later with partial hypopituitarism, as reported in 1. Treatment involves hormone replacement therapy, including levothyroxine, hydrocortisone, estrogen-progesterone combinations, and growth hormone if deficient, as noted in 2, 1, 5. It is essential to have a high index of suspicion for Sheehan syndrome in women with a history of postpartum hemorrhage, as delayed diagnosis can lead to long-term morbidity, as emphasized in 5.