When giving birth, blood loss is normal but it should be within normal range. But sometimes, hemorrhage occurs which puts the birthing mother at risk for hypovolemic shock which can lead to death because of the insufficient blood flow to vital organs. This condition can lead to Sheehan’s syndrome or postpartum hypopituitarism. This problem damages the pituitary gland which is found at the base of the brain due to lack of blood supply and oxygen to major organs in the body.
The pituitary gland is a small bean-shaped gland located at the base of the brain. It is divided into 2- the anterior pituitary and the posterior pituitary gland. Its main function is to secrete hormones that will stimulate other glands like the adrenal, thyroid, ovaries and testes, thus it is called as the “master gland” the anterior pituitary gland secretes different hormones like growth hormones, prolactin, adrenocorticotropic hormone. The posterior pituitary hormone secretes oxytocin which should be secreted after the vaginal labor. It also stimulates the nipples which is essential in breastfeeding.
Sheehan’s syndrome was described by Harold Leeming Sheehan, a British pathologist in 1937. This condition is rare and there is no concrete date as to the occurrence of this condition.
Sheehan’s Syndrome Symptoms
In Sheehan’s syndrome, the symptos appear slow. Usually it appears after a few months or even years after giving birth. Sometimes, it appears right away for breast-feeding mothers. Sometimes, the symptoms are often associated with child bearing or being a new mother like fatigue and weight gain. Thus, an individual experiences the following:
- Difficulty in breast-feeding or the inability to breast-feed
- Loss of pubic or axillary hair
- Slowed mental function
- Weight gain
- Difficulty to stay warm
- Amenorrhea or no menstrual periods
- Low blood pressure
- Fatigue and weight loss
Sheehan’s Syndrome Causes
Sheehan’s syndrome is a very rare condition but the chances of hemorrhage or heavy bleeding in childbirth is given and often anticipated. With that, immediate actions are made by doctors like blood transfusion. The cause of the syndrome is still unknown but a theory states that in pregnancy, the pituitary gland enlarges making it prone to damage and injuries.
This is because the pituitary hormone needs to secrete larger amount of hormones like the follicle-stimulating hormone, leutinizing hormone and the prolactin. However, although there is an increase in size, the blood supply does not increase simultaneously. During the sever blood loss in giving birth, the blood loss can cause tissue death to the pituitary gland impairing it from its function.
Although genetic tendencies are of having Sheehan’s syndrome is not recorded, the risk for acquiring this condition includes multiple pregnancies and problems with the placenta during pregnancy.
Sheehan’s Syndrome Treatment
To treat the problem, Sheehan’s syndrome needs to be diagnosed. But diagnosing the condition is difficult. When the physician reviews the medical history, it is important to include the previous childbirth aside from telling the signs and symptoms felt. In diagnosing the syndrome, hormone levels are checked. There is usually a remarkable low level of TSH or thyroid stimulating hormones, ACTH or adrenocorticotropic hormone, FSH or follicle-stimulating hormone and LH or leutinizing hormone. There are also low levels of T4, cortisol and estradiol in the blood.
Imaging tests like CT scans and MRIs or magnetic resonance imaging are also needed so that it gives a better view of the pituitary gland and the damage done into the master gland.
Treatment of Sheehan’s syndrome includes a lifelong treatment of hormone replacement. Medications include:
Drugs like prednisone and hydrocortisone are used to replace the adrenal hormones that produce adrenocorticortropic hormone. This hormone is essential for growth and metabolism. Corticosteroids should be taken religiously but it should be taken in low doses since high doses can lead to weight gain and high blood glucose which can lead to diabetes.
Corticosteroid doses should not be adjusted because it can lead to serious illnesses and even more stress since the body will release a stress hormone called cortisol.
2. Growth hormones
Since the pituitary gland secretes growth hormones, supplements should be taken. Even though women will stop growing at the age of 18 growth hormones helps normalize the muscle-to-fat ratio and it also helps lower cholesterol.
Since the thyroid gland is affected with Sheehan’s syndrome, there is a significant decrease in the thyroid hormone level because of the low TSH or thyroid-stimulating hormone production. Thus, Levothyroxine should be taken. This drug is inexpensive and it has no side effects and the patient will generally improve their condition. What is important is the patient should not miss any dosage or they should not abruptly stop taking the drug.
Estrogen supplements can come in patches or pills and even through injections. it helps the secretion of Luteinizing hormones and Follicle-stimulating hormone. When taking the pills, there are different kinds of pills available in the market. Estrogen supplement is very much needed in patients whose uterus is removed or undergoing hysterectomy. A combination or estrogen and progesterone may be taken if hysterectomy is not done. Women should be warned however when taking estrogen supplements because it increases the risk of stroke, blood clots in legs.
Once Sheehan’s syndrome is detected and treated right away, the prognosis is good. however, if it is left untreated, complications will arise like:
- Low blood pressure
- High cholesterol
- Weight loss that is unintended
- Menstrual irregularities
- Unexplained fatigue or body weakness
- Adrenal crisis
This is a life-threatening situation characterized by low blood pressure, shock, coma and even death. Aside from that, the early symptoms would include dizziness, muscle aches, nausea, vomiting and diarrhea. The low blood pressure even falls further when standing up- called as orthostatic hypotension.
This is caused by stress, and even sudden withdrawal of long-term corticosteroid therapy. If adrenal crisis happens, it is important to call for help or 911 right away because this condition is fatal. treatment for adrenal crisis would include giving of intravenous fluid to correct hypotension and giving of corticosteroids like prednisone, hydrocortisone, dexamethasone and others.
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