Sheehan'S Syndrome

Sheehan’s syndrome, is also called postpartum hypopituitarism, as it is a condition that is life-threatening to women who have severe low blood pressure or lose a life-threatening amount of blood during or after birth.

This ailment is a major threat to women in developing countries.

This state will deprive women’s body of oxygen which can seriously damage vital tissues and organs, specific damage occurs in the pituitary gland.

The pituitary gland is a small gland found at the base of the brain.

Sheehan’s syndrome thus causes the permanent underproduction of essential pituitary hormones (hypopituitarism), therefore treatment of this condition involves hormone replacement therapy.

For many women, symptoms of Sheehan’s syndrome are non-specific and often times attributed to other conditions.

Fatigue, for instance, is common to new mothers.

Hence, you might not know that you already have Sheehan’s syndrome until you need treatment for thyroid and adrenal insufficiency.

That is why signs and symptoms of Sheehan's syndrome to watch out for are related to the deficiencies of the various hormones controlled by the pituitary gland, such as thyroid, adrenal, breast milk production and menstrual function.

Such signs and symptoms include:

• no menstrual periods also called amenorrhea or infrequent menstruation known as oligomenorrhea,
• difficulty breast-feeding or an inability to breast-feed,
• low blood pressure and irregular heartbeat,
• loss of pubic or underarm hair,
• fatigue,
• slowed mental function,
• weight gain and difficulty staying warm as a result of an underactive thyroid (hypothyroidism),
• and loss of sexual drive.

Signs and symptoms of Sheehan’s syndrome typically appear slowly, after a period of months or even years.

But sometimes, such as in breast feeding mothers, problems may appear right away.

It is also possible to remain relatively symptom-free with Sheehan’s syndrome, some women even live for years not knowing that their pituitary is no longer working normally.

Symptoms depend on the extent of damage to the pituitary gland which can then be triggered by an extreme physical stressor such as a severe infection or surgery that can cause adrenal crisis.

There are many factors that can cause the pituitary to not function properly, in the case of Sheehan’s syndrome severe blood loss or extremely low blood pressure during or after childbirth is the cause.

Such problems can be particularly damaging to the pituitary gland, which leads to the destruction of the hormone-producing tissue causing the gland to malfunction.

The Endocrine system is regulated by the Pituitary hormones, it signals other glands to increase or decrease production of hormones that control

• blood pressure,
• metabolism,
• fertility,
• breast milk production
• and many other vital functions.

A lack of any of these important regulating hormones can cause problems throughout the body function, although signs and symptoms may gradually appear and may even go unnoticed.

Hormones that the pituitary gland secretes include:

Growth Hormone (GH)

This hormone controls bone and tissue growth and maintains the right balance of muscle and fat tissue.

Thyroid-stimulating hormone (TSH)

This hormone stimulates the thyroid gland to produce key hormones that regulate metabolism.

Shortage of TSH results in an underactive thyroid gland also called hypothyroidism.

Anti-diuretic hormone (ADH)

This hormone manages water balance in the body by regulating urine production. A deficiency of ADH results in excess urination and thirst, this condition is called diabetes insipidus.

Luteinizing hormone (LH)

In men, LH regulates testosterone production while in women it fosters production of estrogen.

Follicle-stimulating hormone (FSH) is working in tandem with LH, as FSH helps stimulate sperm production in men and egg development and ovulation in women.

Prolactin

This hormone regulates the development of female breasts as well as the production of breast milk.

Adrenocorticotropic hormone (ACTH)

This hormone stimulates your adrenal glands to produce cortisol and other hormones.

Cortisol helps the body to deal with stress and influences many body functions including

• heart function,
• blood pressure regulation
• and immune system.

A low level of adrenal hormones caused by pituitary damage is called secondary adrenal insufficiency.

Diagnosing Sheehan’s syndrome can be difficult as many of the symptoms overlap with other conditions.

That is why when your primary care doctor suspects it, you’ll most likely be referred to an endocrinologist which is a doctor who specializes in hormonal disorders.

There are a number of things you need to prepare to help you optimize the appointment with your doctor.

First, be aware of any pre-appointment restrictions so as not to waste your time getting ready. When you make your appointment, be sure to ask if there is anything you need to do to prepare for the specific diagnostic tests that you will undergo through.

Make a list of your key medical information, including the names of all medications you are taking, recent surgical procedures and any other conditions for which you have been treated.

Bring your medical records from any previous pregnancies, especially those on labor, delivery and miscarriage.

Write down all symptoms and changes you have been experiencing even if you feel that they are unrelated or is commonly felt.

It is also important that you are accompanied by a family member or a friend, as it can be taxing to remember all medical information that you will learn and will be explained during your appointment.

Having someone with you during the appointment may help remember things that you forgot and unable to notice which can prove important in understanding your condition.

It will also go in handy to have a list of questions for your doctor which you should prepare before the appointment as this will help you make the most of the time together.

Here are some common questions to ask your doctor related to Sheehan’s syndrome:

• Is Sheehan’s syndrome temporary, or will I always have it?
• What’s the most likely case of my symptoms?
• What kinds of tests do I need?
• What treatments are available, and what do you recommend for me?
• Will I be able to have another child?
• Is there a generic alternative to the medicine you are prescribing?
• I have other health conditions, how can I best manage these conditions together?
• Do you have any reading materials I can take home for guidance?
• Are there any dietary or activity restrictions I need to follow?

Part of assessing your condition, expect that your doctor will ask a number of questions which will help diagnosis the symptoms.

Here are the likely questions from your doctor:

• Did you have any other complications during childbirth?
• Did you bleed heavily after your delivery?
• Do you have symptoms all the time, or do they come and go? When did you begin experiencing the symptoms?
• Does anything seem to aggravate your symptoms?
• Is there anything that seems to improve your symptoms?

Answering these questions as accurately as possible plays a vital role in helping diagnose the condition as thorough medical history would need to be collected.

Hence, you must mention any childbirth complications encountered no matter how long ago you have given birth.

Also, the two key signs of Sheehan’s syndrome are inability to produce breast milk and failing to start menstruating after delivery, therefore you must also mention these signs if you have experienced them.

The next step is for your doctor to run a few tests if pituitary insufficiency is suspected, such as a blood test to check pituitary hormone levels.

A pituitary hormone stimulation test may also be requested.

You may need specialized stimulation testing for pituitary hormones, this includes the injection of hormones and repeated blood tests to see how much your pituitary responds to the stimulus.

This test is typically done after consulting with an endocrinologist.

Imaging tests will be requested as well. Imaging tests may also be needed such as magnetic resonance imaging or computerized tomography, to rule out other possible reasons for your symptoms such as a pituitary tumor as well as to check the size of your pituitary.

Lifelong hormone replacement therapy is the treatment for Sheehan’s syndrome.

Your endocrinologist is likely to test your blood regularly to make sure that you're getting adequate — but not excessive — amounts of any hormones that you take. Generally, hormone levels are checked every few months at the beginning of treatment and then once a year thereafter.

Your doctor may recommend one or more of the following medications:

Levothyroxine (Levoxyl, Synthroid, others)

This medication boosts deficient thyroid hormone levels caused by low or deficient thyroid-stimulating hormone (TSH) production.

If you change brands, let your doctor know to ensure you're still receiving the right dosage. Also, don't skip doses or stop taking the drug because you're feeling better. If you do, signs and symptoms will gradually return.

Corticosteroids

These drugs, such as hydrocortisone or prednisone, replace the adrenal hormones that aren't being produced because of an adrenocorticotropic hormone (ACTH) deficiency. You'll need to adjust your medication if you become seriously ill or experience major physical stress.

During these times, your body would ordinarily produce extra cortisol — a stress hormone. The same kind of dosage fine-tuning may be necessary when you have the flu, diarrhea or vomiting, or have surgery or dental procedures.

Adjustments in dosage may also be necessary during pregnancy or with marked weight gain or weight loss. Avoiding doses higher than you need will eliminate the side effects associated with high doses of corticosteroids.

Estrogen

This may include estrogen alone if you've had your uterus removed (hysterectomy) or a combination of estrogen and progesterone if you still have your uterus. Estrogen use has been linked to an increased risk of blood clots and stroke in women who still make their own estrogen.

The risk should be less in women who are replacing missing estrogen. And while estrogen replacement is available in either pills or patches, the patches seem to have a lower risk of side effects.

Future pregnancies may be possible with preparations containing luteinizing hormone (LH) and follicle-stimulating hormone (FSH), also called gonadotropins. These can be administered by injection to stimulate ovulation.

After age 50, which is around the time of natural menopause, discuss the risks and benefits of continuing to take estrogen or estrogen and progesterone with your doctor.

Growth hormone

Some studies have shown that replacing growth hormone in women with Sheehan's syndrome — as well as in people with other forms of hypopituitarism — can help normalize the body's muscle-to-fat ratio, lower cholesterol levels and improve overall quality of life. Side effects may include joint stiffness and fluid retention.Streptococcus pyogenes is the bacteria responsible for strep throat. It is highly contagious and spread through air droplets, through shared foods and by infected objects.

After severe bleeding during childbirth, there is no known prevention for Sheehan's syndrome.

Women with severe bleeding during  or after birth should consuly with their doctor about blood tests to evaluate their hormonal levels.

However, in many cases this extreme bleeding during childbirth can be prevented with proper medical care, which in turn would prevent Sheehan syndrome.

Currently, there are no known alternative and homeopathic remedies for Sheehan's syndrome. Primary source of treatment of management of the condition is by taking a lifelong hormone therapy.

Coping with Sheehan's syndrome can be better achieved once you have better understanding of the condition. Hence make sure that upon seeking medical advice that you do not hesitate to ask your doctor on things that are bothering you or are confusing for you.

Having ample emotional support from your family and friends could also help deal with this condition.

Lifestyle changes would need to be considered as you would need to make sure that you are living a healthy lifestyle free from vices and able to have regular exercises to boost your immune system since part of the medication is lifelong hormone replacement therapy.

There are several risks and complications associated with Sheehan's syndrome.

Sheehan's syndrome can cause a number of problems, since pituitary hormones control so many aspects of your metabolism, such as:

• adrenal crisis,
• low blood pressure,
• unintended weight loss
• and menstrual irregularities.

Adrenal crisis is a life-threatening situation and the most serious complication of Sheehan’s syndrome.

Adrenal crisis is a serious condition in which your adrenal glands produce too little of the hormone cortisol that can lead to extremely low blood pressure, shock, coma and death. Adrenal crisis usually occurs when your body is under marked stress — such as during surgery or a serious illness — and your adrenal glands produce too little cortisol, a powerful stress hormone. Because of the potentially serious consequences of adrenal insufficiency, your doctor is likely to recommend that you wear a medical alert bracelet.

Any condition that increases the chance of severe blood loss (hemorrhage) or low blood pressure during childbirth, such as being pregnant with multiples or having a problem with the placenta, may increase your risk of Sheehan's syndrome. Hemorrhage is a rare childbirth complication, however, and Sheehan's syndrome is even more uncommon.

Both risks are greatly reduced with proper care and monitoring during labor and delivery.