Diagnosis and treatment challenges of Sheehan's Syndrome

Abstract

Sheehan's Syndrome is a chronic health condition specific to women who have experienced postpartum hemorrhage. It is characterized by varying degrees of pituitary hormone imbalance related to the pathological process of pituitary gland necrosis after hemorrhage has occurred. Though the syndrome is a rare complication of hemorrhage, diagnosis is often substantially delayed due to the circumstances surrounding delivery and the broad spectrum of clinical presentation. The aim of this paper is to explore the complexities of the syndrome in an effort to help practitioners provide early diagnosis and appropriate treatment to women with the condition. This is achieved by synthesizing relevant and recent literature about immediate and delayed presentations of the condition via the frame of a clinical vignette.

A Challenging Diagnosis of Sheehan’s Syndrome in Non-obstetric Critical Care and Emergency Settings: A Case Series of Five Patients with Varied Presentations

“…Usually, the evolution of the disease is chronic with subtle and non-specific features [9] like fatigue, headache, nausea, vomiting, psychiatric features [10] and depressive disorders. But, as the disorder progress, patients may present in ER with severe organ dysfunctions like coma, hypotension, dyselectrolytemias (eg hyponatremia), hypoglycaemia, seizures, pancytopenia, rhabdomyolysis, coagulopathy and renal failure [6]. In view of varied spectrum of presentation, a meticulous approach is warranted for a timely diagnosis.…”

“…Severity of disease depends upon the number of hormonal axes affected by destruction of pituitary gland. Sheehan's syndrome generally occurs if 70-90% of the gland has been destroyed [6].…”

Case report: Pancytopenia as a rare presentation of Sheehan’s syndrome

“… 1 Diagnosis is first made by a thorough clinical history and physical examination, supported by the appropriate laboratory tests including anterior pituitary hormones levels. 3 , 8 The abnormalities are not only limited to the hormone levels but also include hyponatremia, which occurs mainly due to adrenal insufficiency. 10 Although rare, this also includes hematologic abnormalities, including anemia and even pancytopenia, which can occur in up to 65% of patients with Sheehan syndrome.…”

“…The diagnosis of Sheehan’s syndrome was confirmed with a combination of clinical and laboratory findings, supported by the magnetic resonance imaging findings. 8 The patient was started on hormone replacement therapy of hydrocortisone 20 mg per day, followed by L-Thyroxine 50 µcg per day with an increment dose.…”

“…[4][5][6][7] The spectrum of clinical presentation of Sheehan's syndrome is broad, starting at first with failure to lactate the baby and to restore normal menstrual cycle, but this aspect of the condition can oftentimes be overlooked because emergent hysterectomies are performed to treat unstable postpartum hemorrhage. 8 Then, symptoms may continue with nonspecific complaints, such as weakness, fatigue, headache, and pallor, and may end up with severe pituitary insufficiency, resulting in coma and death. 9 The anterior pituitary gland is more susceptible to damage than the posterior part.…”