What Is Sheehan Syndrome?

Due to postpartum hemorrhage, especially with prolonged hemorrhagic shock, hypoxia, degeneration and necrosis of the anterior pituitary gland tissue, followed by fibrosis, eventually lead to anterior pituitary hypofunction syndrome. The incidence of postpartum hemorrhage and hemorrhagic About 25% of patients with shock. Studies in recent years show that the occurrence of Sheehan syndrome is not only related to anterior pituitary hypofunction. Some patients have reported signs of anterior pituitary hypofunction, and 50% of them show abnormalities in the posterior pituitary function.

Basic Information

English name: Sheehan syndrome
Visiting department: Obstetrics and Gynecology; Internal Medicine
Multiple groups: Maternal

Common causes: Postpartum hemorrhage caused hypoxia, degeneration and necrosis of anterior pituitary tissue, fibrosis, resulting in anterior pituitary hypofunction
Common symptoms: Weakness, weakness, no milk secretion, secondary amenorrhea, secondary infertility. Loss of libido, vaginal dryness, difficulty in coping, etc.

Causes of Sheehan Syndrome

Pituitary hypertrophy and increased oxygen demand during pregnancy are particularly sensitive to hypoxia. After delivery, the pituitary gland quickly reverts, blood flow decreases, and its corresponding secreted hormones decrease rapidly. If major bleeding occurs during childbirth, causing hemorrhagic shock, or even DIC, sympathetic reflex excitement causes arterial spasm or even occlusion, reducing or severing blood supply to the pituitary artery, degeneration and necrosis of anterior pituitary tissue, and anterior pituitary and its Various hormones secreted by the target organs under control are drastically reduced, leading to the premature degradation of the functions of the target organs affected by various hormones and causing a series of syndromes.

Clinical manifestations of Sheehan syndrome

The anterior pituitary gland has a strong compensatory function. Symptoms begin to appear when the pituitary tissue is destroyed by 50%; obvious symptoms occur when the pituitary tissue is damaged by 75%; when the pituitary tissue is damaged by more than 95%, a more severe symptom.

When the anterior pituitary is dysfunctional, the most sensitive is the reduction of gonadotropin secretion, which subsequently affects the secretion of thyroid stimulating hormone and adrenergic hormone. The age of onset is mostly 20 to 40 years of age. Amenorrhea can occur from 3 months to 32 years after delivery. The reduction of various hormone secretions caused by anterior pituitary lesions varies in degree, and the clinical manifestations of their corresponding target organ dysfunction are not completely parallel, the onset of which varies from morning to evening, and the severity of the symptoms varies.

Typical manifestations are: during the postpartum period of postpartum hemorrhagic shock, long-term weakness and weakness, the first is no milk secretion, and then secondary amenorrhea, even if the menstrual period recovers, it is rare and secondary infertility. Loss of libido, vaginal dryness, and difficulty coping. Pubic hair, axillary hair fall, thin hair, eyebrows, atrophy of breasts and genitalia, indifferent spirit, lethargy, unpleasant activity, slow response, chills, no sweat, dry and rough skin, poor appetite, constipation, low body temperature, slow pulse , Decreased blood pressure, pale, anemia. Most have edema, weight loss, and a few have wasting cachexia.

Sheehan syndrome test

Laboratory inspection

(1) GH, FSH, LH, ACTH, and PRL were decreased in pituitary hormone detection .

(2) TT3, TT4, T3, T4, and TSH decreased.

(3) Detection of adrenal hormones Cortisol and urinary cortisol decreased, and fasting blood glucose decreased.

(4) Detection of sex hormones Estrogen, progesterone, and testosterone were reduced.

(5) Hematology: Hemoglobin and red blood cells are often reduced, and the hematocrit is decreased.

(6) Immunological tests So far, the occurrence of Sheehan syndrome has not been confirmed to be related to autoimmunity. Immunological tests have shown that the patients' blood tests are negative for anti-pituitary antibodies and pituitary peroxidase antibodies.

2. Imaging examination

Ultrasound examination showed atrophy of the uterus, smaller ovaries, no follicular development, and no ovulation. X-rays of the skull showed no significant changes in the saddle, and CT and MRI of the brain showed smaller atrophy of the pituitary gland. MRI showed that 83% of patients had a pituitary image that could be discerned, but the density was significantly reduced, and even cavity echoes were displayed in the saddle area Called the "empty saddle."

Sheehan syndrome diagnosis

Diagnosis can be made based on the cause, clinical manifestations, and laboratory tests.

Sheehan Syndrome Treatment

According to the specific conditions of low function of thyroid, adrenal cortex and gonad, long-term hormone replacement therapy is given.

General treatment

Strengthen nutrition, exercise properly, supplement vitamins, calcium, and treat anemia.

2. Drug treatment

(1) Adrenal corticosteroids Cortisone or hydrocortisone, or edema, use prednisone or dexamethasone. When there is infection, fever, trauma, or surgery, the dose should be increased appropriately.

(2) Thyroxine Tablets Usually started after taking a few days of adrenocortical hormone.

(3) Sex hormones can use artificial cycle therapy: those who are middle-aged or older may not use it. Young patients take diethylstilbestrol orally, and progesterone is added for the last 5 days. After menstruation, such as menstrual cramps, 3 to 7 days, they can be reused 5 days after bleeding. If you have fertility requirements, you can use HMG or HCG in combination to promote ovulation, and the effect is good.