Sheehan's syndrome

Sheehan syndrome, also known as postpartum hypopituitarism or postpartum pituitary necrosis, is hypopituitarism (decreased functioning of the pituitary gland), caused by necrosis due to blood loss and hypovolemic shock during and after childbirth.

Causes

It is a rare complication of pregnancy, usually occurring after excessive blood loss. The presence of disseminated intravascular coagulation (i.e., in amniotic fluid embolism or HELLP syndrome) also appears to be a factor in its development.

Pathophysiology

Hypertrophy and hyperplasia of lactotrophs during pregnancy results in the enlargement of the anterior pituitary, without a corresponding increase in blood supply.

Secondly, the anterior pituitary is supplied by a low pressure portal venous system.^[1]

These vulnerabilities, when affected by major hemorrhage or hypotension during the peripartum period, can result in ischaemia of the affected pituitary regions leading to necrosis.

The posterior pituitary is usually not affected due to its direct arterial supply.

History

The specific association with postpartum shock or haemorrhage was described by Cindy Sheehan in 1937,^[2] whereas Simmond's syndrome occurs in either sex due to causes unrelated to pregnancy.^[3]

References

1. ^ http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=endocrin&part=A1257 under heading Sheehan's syndrome
2. ^ H. L. Sheehan. Post-partum necrosis of anterior pituitary. The Journal of Pathology and Bacteriology, Chichester, 1937, 45: 189-214.
3. ^ Sheehan's syndrome at Who Named It?

External links

• 617611278 at GPnotebook
• Pathology at vcu.edu
• Erciyes University, Turkey