Sheehan syndrome

From WikiLectures

Definition, pathogenesis, symptoms, complications, treatment.

Sheehan syndrome is a postpartum ischemic necrosis of the pituitary of the mother. The pituitary gland itself tends to be enlarged (2–3×) during pregnancy and is therefore more susceptible to damage. Blood loss and hypotension occur during childbirth. Massive blood loss causes blood vessels to spasm in various parts of the body. Significant vasoconstriction also occurs in the vessels that supply blood to the hypothalamus and then continue to the pituitary gland. Contraction of these vessels results in Ischemia of the pituitary gland. Insufficient blood flow will cause part of the pituitary gland (or even the entire pituitary gland) to die off.

This results in impaired secretion of certain hormones, among which in particular: thyreotropic hormone (TSH), follicle stimulating hormone (FSH), luteinizing hormone (LH) and [[adrenocorticotropic hormone] ] (ACTH). This leads to a disturbance in the synthesis of thyroxine, triiodothyronine, estrogen, progesterone and glucocorticoids.

The first sign of possible damage is the inability to breastfeed in the postpartum period and the failure to resume regular menstruation after 6 weeks postpartum (secondary amenorrhea). Furthermore, there will be hypofunction of the thyroid gland, a reduction in pigmentation and the disappearance of hair. All as a result of pituitary insufficiency.

  • Diagnosis - reduction of pituitary hormone levels.
  • Treatment - lifelong hormone replacement.

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