MIDIRS Midwifery Digest Hot Topic: Sheehan’s syndrome: no milk? Think Sheehan’s!
By Jennifer Kenworthy, Claire Barlow on 22 March 2022
Sheehan’s syndrome (postpartum hypopituitarism) was first described in 1937 by Harold Leeming Sheehan (1900-1988). He described it as pituitary gland necrosis following postpartum haemorrhage or hypovolemia (Sheehan 1937).
There are many questions regarding the pathophysiology behind Sheehan’s syndrome and there have been calls for further research into whether hypoperfusion is enough to explain the tissue necrosis, or whether factors such as anti-pituitary antibodies or small cella size are also involved (González-González & Borjas-Almaguer 2018). Indeed, a case reported in 2020 had no inciting factors, such as haemorrhage or hypovolemia (Sethuram et al 2020).
In recent years, attention has shifted away from Sheehan’s syndrome in developed countries as a result of advances in obstetric care. A 2011 Icelandic study found a prevelance of 5.1 in 100,000. It concluded that this figure was surprisingly high and likely to be underestimated due to delayed diagnosis or misdiagnosis (Kristjansdottir et al 2011).
In developing countries, such as India, the prevalence has been found to be 3100 in 100,000 (Shivaprasad 2011). Symtoms may appear in the initial postnatal period (acute) or over time (chronic) depending on the degree of tissue damage (Hao et al 2012). In developed countries the time to disagnosis for women with chronic Sheehan’s syndrome is 9 ± 9 years whereas, in developing countries, it is 20 ± 8 years (Jose et al 2019).
Symptoms of Sheehan’s syndrome
Women with Sheehan’s syndrome have varying levels of pituitary dysfunction (Shivaprasad 2011), the most life-threatening being hypocorticolism (lack of the hormone cortisol) (Dahan & Tan 2015). This is caused by adrenocorticotrophic hormone (ATCH) deficiency; ATCH is released by the pituitary (Shivaprasad 2011). It is vital that this is detected and treated early with glucocorticoid replacement to avoid risk of coma or death in adrenal crisis (González-González & Borjas-Almaguer 2018). Risk of adrenal crisis may present in the postpartum period or much later when the woman undergoes a stressor, as as surgery or illness (Shivaprasad 2011).
Kenworthy J, Barlow C. MIDIRS Midwifery Digest, vol 32, no 1, March 2022, pp 6-9.
Original article © MIDIRS 2022
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