Sheehan Syndrome

What is Sheehan syndrome?

Sheehan syndrome is a rare condition involving injury to your pituitary gland following extreme blood loss during childbirth. With Sheehan syndrome, severe blood loss deprives your pituitary gland of the oxygen it needs to work properly. As a result, some of the tissue in your pituitary gland dies.

Damage to your pituitary gland can have widespread effects on your body because it’s a “master gland.” Not only does your pituitary gland secrete hormones that spur important processes in your body, but it also tells other glands to secrete hormones. Your pituitary gland helps regulate processes that impact your brain, skin, energy, mood, reproductive organs, growth and more.

Sheehan syndrome is also called postpartum hypopituitarism or pituitary infarction.

How common is Sheehan syndrome?

Sheehan syndrome is extremely rare, occurring in approximately 5 out of every 100,000 births. It’s more common when there is inadequate emergency care available to prevent life-threatening blood loss in complicated pregnancies.

How does Sheehan syndrome affect my body?

Damage to your pituitary gland can cause your body to produce too little of the hormones it needs to carry out important processes. Depending on the extent of the injury, you may have the following hormone deficiencies:

• Adrenocorticotrophic hormone (ACTH): Stimulates the production of your body’s primary stress hormone, cortisol. Cortisol maintains your blood pressure and blood sugar levels. It helps your body productively respond to strain and stress.
• Thyroid-stimulating hormone (TSH): Stimulates the thyroid gland, which regulates metabolism, energy and your nervous system.
• Growth hormone (GH): Helps maintain your bone density, muscle mass and fat distribution.
• Follicle-stimulating hormone (FSH): Stimulates estrogen production in your ovaries and causes an egg to grow every month.
• Luteinizing hormone (LH): Stimulates ovulation (when your ovaries release an egg) during your menstrual cycle.
• Prolactin (PRL): Stimulates lactation (the production of milk) during pregnancy and allows you to breastfeed (chestfeed).
• Antidiuretic hormone (ADH or vasopressin): Regulates and balances water and sodium levels in your body. Low levels of ADH can cause diabetes insipidus (disease caused by problems with regulation of water and salt levels in your body) in 5% of people with Sheehan syndrome.

What are the signs and symptoms of Sheehan syndrome (postpartum hypopituitarism)?

With acute cases of Sheehan syndrome, you’ll notice symptoms right away. More often, symptoms present gradually over several months or several years.

Symptoms may include:

• Trouble breastfeeding or your milk never coming in after your baby is born.
• No longer getting periods (amenorrhea) or having infrequent periods.
• Thinning vaginal walls and vaginal dryness (vaginal atrophy) that make intercourse painful.
• Uncontrollable urge to drink water or frequent urination both day and night.
• Breast shrinkage and loss of pubic and armpit hair.
• Weight gain or a decrease in muscle mass.
• Intolerance to cold temperatures.
• Fatigue and trouble concentrating.
• Low sex drive.
• Dry skin.

You may not notice symptoms until you experience a stressful life event — like surgery, an infection or injury — and symptoms start because your body doesn’t have enough stress hormone to respond to the stressor. This is called an adrenal crisis. An adrenal crisis requires immediate medical attention.

What causes Sheehan syndrome?

Losing too much blood during childbirth deprives your pituitary gland of the oxygen it needs to stay healthy and can lead to cell death. Your pituitary gland grows during pregnancy and can even double in size. The size increase makes it especially vulnerable to injury if it doesn’t get enough oxygen.

As a result, your pituitary gland can’t produce enough of the hormones needed to regulate certain body functions. Insufficient hormones can negatively impact several of your body’s common functions. Hormone deficiencies resulting from a pituitary gland injury can slow or stop processes related to your reproductive system, nervous system, etc.

How much blood loss is associated with Sheehan syndrome?

You lose a life-threatening amount of blood. The blood loss can lead to a severe drop in blood pressure, shock or even death. Fortunately, most care teams are prepared for emergencies like these so your risk of developing Sheehan syndrome is incredibly low.

Is Sheehan syndrome an autoimmune disease?

Sheehan syndrome may be related to an autoimmune response in your body. With autoimmune diseases, your immune system (which normally fights “bad” invaders that can harm your body, like viruses) attacks healthy cells instead. Researchers have found that some – but not all – people with Sheehan syndrome have antibodies that attack the pituitary gland.

More research is needed to understand autoimmune responses in Sheehan syndrome.

How is Sheehan syndrome diagnosed?

Your healthcare provider may use the following to make a diagnosis if you’re experiencing symptoms of Sheehan syndrome:

• Medical history. Tell your provider about any blood loss or other complications you experienced during previous childbirths. Let them know about any symptoms afterward (for instance, having trouble producing breast milk or not resuming periods). Communicate with your provider about any symptoms you’re experiencing, including when they occur and what improves them.
• Blood tests. Giving blood will allow your provider to check the hormone levels associated with your pituitary gland’s functioning.
• Imaging. An MRI can allow your provider to rule out other causes of your symptoms, like a tumor on your pituitary gland. They may order a CT scan if the MRI results are inconclusive.

How do you test for Sheehan syndrome (postpartum hypopituitarism)?

Your provider may check your hormone levels directly, or they may see how your pituitary responds to certain stimulants.

• Tests to check hormone levels. Your provider may check hormones like ACTH, FSH, LH, TSH, T4, estradiol (a type of estrogen), IGF-1, and cortisol.
• Stimulation tests. Your provider may give you medicine or an injection to stimulate the production of certain pituitary hormones so that they can assess how your pituitary gland responds.

How is Sheehan syndrome treated?

You’ll have to take hormones for the rest of your life to replace the ones that your body is no longer making. These hormones may include:

• Corticosteroids: You can take hydrocortisone (Cortef®) or prednisone (Rayos®) to make up for an adrenocorticotropic hormone (ACTH) deficiency. Your dosage may need to be adjusted if you’re going through a high-stress situation that requires your body to ramp up cortisol production (like surgery).
• Thyroid hormones: You can take levothyroxine (Levoxyl®, Levo-T®, Synthroid®, Unithroid®) to make up for TSH deficiency. The dosage of medication will be adjusted based on your thyroid hormone levels.
• Sex Hormones: You can take hormones to help regulate your periods, help with pregnancy, and help with premature menopause symptoms. Medications include estrogen and/or progesterone.
• Growth hormones: Taking growth hormones may help increase your muscle mass if you’re experiencing declines related to your pituitary gland function.

How can I reduce my risk?

You can’t reduce your risk. Take comfort in knowing that Sheehan syndrome is rare. Having a capable care team that can prevent pregnancy complications like severe blood loss greatly reduces your risk of Sheehan syndrome.

What can I expect if I have Sheehan syndrome?

With treatment, the prognosis for Sheehan syndrome is excellent. Most people go on to live healthy lives. Many have successful pregnancies following their diagnosis, with careful observation from their care team.

A specialist called an endocrinologist will likely play a key role in your care moving forward. An endocrinologist specializes in treating conditions involving your hormones. Expect regular visits to your endocrinologist to ensure that you’re receiving the right amount of medication you need to make up for any hormone deficiencies.

When should I go to the ER?

You should seek emergency care if you’re experiencing an adrenal crisis, which can be life-threatening without treatment. Symptoms include:

• Light-headedness.
• Abdominal, lower chest, or back pain.
• Fever.
• Weakness.
• Nausea and vomiting.
• Confusion or loss of consciousness.

If your healthcare provider believes you’re at risk, you may need to wear a medical alert bracelet to get immediate care in an emergency.

What questions should I ask my doctor?

• How does Sheehan syndrome affect my body?
• How will treatment improve my symptoms?
• Is pregnancy possible with Sheehan syndrome?
• How often will I need blood tests?
• What medications or treatments do you recommend?
• How can I adjust my lifestyle to live a healthy life with Sheehan syndrome?
• Will I need to wear a medical alert bracelet?

A note from Cleveland Clinic

Damage to your pituitary gland can impact multiple processes in your body that rely on healthy hormone levels. Hormone replacement can offset some of the effects of a hormone deficiency. Ask your healthcare provider about how Sheehan syndrome may impact your lifestyle and overall well-being. Discuss how frequently your hormone levels will need to be checked to ensure you’re receiving the right medication needed to support your health.