Sheehan’s syndrome: a case report and literature review
DOI:
https://doi.org/10.18597/rcog.321Keywords:
panhypopituitarism, Sheehan's syndrome, pituitary necrosisAbstract
Introduction: postpartum pituitary necrosis, or Sheehan’s syndrome, occurs following obstetric haemorrhage which causes intense circulatory collapse, thereby predisposing pituitary ischemia leading to this organ becoming enlarged (the posterior pituitary is generally affected). This document presents a clinical case of a patient who consulted due to late manifestations of this syndrome. A literature review is also made.
Objective: presenting the case of a patient who consulted for late manifestations of Sheehan’s syndrome and reviewing the pertinent literature.
Methodology: information was sought in the PubMed / Medline, Cochrane, SciELO databases and references from articles in journals and texts (mainly from the last five years) were also taken into account. The seven most relevant articles were taken according to the impact of the journal in which they were published.
Results: the most frequently found clinical characteristic was an inability to lactate due to insufficient prolactin production. The most common clinical feature found was an inability to breastfeed due to insufficient prolactin production. Other manifestations included inappropriate antidiuretic hormone secretion and cortisol, thyroid hormone and gonadotropin secretion deficiencies. Obstetricians and GPs should be able to recognise this syndrome and know about its management as the acute loss of adenohypophysis functioning may have a poor prognosis without timely and suitable hormone replacement. Good hormone control prevents or decreases metabolic and cardiovascular complications.
Conclusion: this is a rare syndrome in which early diagnosis is difficult and requires hormone replacement therapy with ongoing clinical and laboratory controls.
Author Biographies
Eduardo Contreras-Zúñiga
Ximena Mosquera-Tapia
María Cristina Domínguez-Villegas
Erika Parra-Zúñiga
References
Sheehan HL. Postpartum necrosis of anterior pituitary. J Pathol Bact 1937;45:189-214.
Soares DV, Conceição FL, Vaisman M. Aspectos diagnósticos e terapêuticos da síndrome de Sheehan. Arq Bras Endocrinol Metab 2008;58:872-8.
Yamada M, Mori M. Mechanisms related to the pathophysiology and management of central hypothyroidism. Nat Clin Pract Endocrinol Metab 2008;4:683-94.
Feinberg EC, Molitch ME, Endres LK, Peaceman AM. The incidence of Sheehan's syndrome after obstetric hemorrhage. Fertil Steril 2005;84:975-9.
Ozkan Y, Colak R. Sheehan syndrome: clinical and laboratory evaluation of 20 cases. Neuro Endocrinol Lett 2005;26:257-60.
Kovacks K. Sheehan syndrome. Lancet 2003;361:520-2.
Shrager S, Sabo L. Sheehan syndrome: a rare complication of postpartum hemorrhage. J Am Board Fam Pract 2001;14:389-91.
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Copyright (c) 2009 Revista Colombiana de Obstetricia y Ginecología
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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