Sheehan’s syndrome

Sheehan’s syndrome


INTRODUCTION:

  • It is the syndrome which results from ischaemic necrosis of most of the Anterior Pituitary due to spasm in its arterioles occurring at the time of severe hemorrhage or shock complicating childbirth.
  • It is a rare cause of panhypopituitarism
  • Only the anterior pituitary is affected because in parturient woman, blood supply to the pituitary gland is modified to the advantage of the posterior lobe and disadvantage of the anterior lobe so, when spasm occurs, posterior lobe is protected.
  • When 75% of Anterior pituitary is destroyed, manifestations of Sheehan’s syndrome appear 
  • When 95% is destroyed — fully developed Simmonds syndrome is seen.
  • Hormones of Anterior Pituitary are affected in order of frequency = GH, FSH and LH, TSH and ACTH.

SYMPTOMS:

  • Failure of lactation after delivery
  • Secondary amenorrhoea
  • Loss of libido
  • Increased sensitivity to cold (hypothydroidism)

SIGNS:

  • Absence of axillary sweating 
  • Loss of axillary and pubic hair
  • Signs of adrenal cortical failure
  • Decrease in skin pigmentation
  • Anemia due to lack of pituitary erythropoeitic factor
  • Weakness, lethargy
  • Hypothermia
  • Hypoglycemia (due to decreased insulin tolerance)
  • All genital organs show atrophy, uterus is smaller than in postmenopausal women° as there is decrease in FSH, LH & estrogen
  • Although dormant ovaries retain their ova till menopause
  • Difficulty breast-feeding or an inability to breast-feed
  • No menstrual periods (amenorrhea) or infrequent menstruation (oligomenorrhea)
  • Slowed mental function, weight gain and difficulty staying warm as a result of an underactive thyroid (hypothyroidism)
  • Low blood pressure (hypotension)
  • Fatigue
  • Irregular heartbeat
  • Breast shrinkage

COMPLICATIONS:

  • Adrenal crisis, a serious condition in which your adrenal glands produce too little of the hormone cortisol
  • Low blood pressure
  • Unintended weight loss
  • Menstrual irregularities

INVESTIGATIONS

The diagnosis is established by:

  • Measuring plasma levels of growth hormone and cortisol after an insulin challenge
  • Evaluating thyroid hormones and TSH levels
  • Skull x-ray shows:  empty sella     
  • FSH
  • LH
  • ACTH 
  • Oestrogens 
  • Urinary 17 keto steroids

MANAGEMENT:

  • Corticosteroids. These drugs, such as hydrocortisone or prednisone, replace the adrenal hormones that aren’t being produced because of an adrenocorticotropic hormone (ACTH) deficiency.
  • Levothyroxine (Levoxyl, Synthroid, others). This medication boosts deficient thyroid hormone levels caused by low or deficient thyroid-stimulating hormone (TSH) production.
  • Estrogen. Alone in hysterectomy or a combination of estrogen and progesterone.
  • Growth hormone. Help to normalize the body’s muscle-to-fat ratio, maintain bone mass, lower cholesterol levels and improve overall quality of life.
Exam Question
 
  • Empty sella in skull x-ray,amenorrhea  & failure of lactation following  delivery are seen in Sheehan’s syndrome
  • Amenorrhoea, Failure to lactate & Absence of secondary sexual characteristics are seen with Sheehan’s syndrome
  • Cortisone  is essential in Sheehan’s syndrome
Don’t Forget to Solve all the previous Year Question asked on Sheehan’s syndrome

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