Sheehan’s Syndrome (Excessive Bleeding During Childbirth)

Sheehan’s syndrome is a medical condition that affects women who lose an excessive amount of blood during childbirth or have low blood pressure during and after labour, which can deprive their body of oxygen. The lack of oxygen that causes damage to their pituitary gland is known as Sheehan’s syndrome. Its treatment includes blood tests, scans, and hormone replacement therapy!

What Is Sheehan Syndrome?

Named after British pathologist Harold Leeming Sheehan, who first explained this disorder in 1937, Sheehan’s syndrome (SS) is also known as postpartum hypopituitarism. He explained that it develops due to ischemic pituitary necrosis as a result of uterine haemorrhage. This loss of blood following the delivery of a baby causes tissue death in the pituitary gland, resulting in almost a third of such cases. As the blood pressure dips during or after labour, the pituitary gland gets starved of blood and the required oxygen to function properly. The pituitary gland or the ‘master gland’ is located at the base of the brain and forms a part of the endocrine system. It secretes certain hormones that affect other organs like the kidneys, thyroid, and uterus.

As this gland grows bigger to almost double its size during pregnancy, it is more vulnerable to injury or sometimes called ‘shock’ during childbirth. If the pituitary gland cells are damaged or die (necrosis), the number of hormones produced by it may decrease, giving rise to hypopituitarism. In such a case, conditions such as single pituitary hormone insufficiency or total hypopituitarism can be noticed. Similarly, thyroid and adrenal glands even lose their ability to release enough hormones, and the functions of these affected organs also decline. Hence, Sheehan’s Syndrome during pregnancy is thought to be one the most common cause of hypopituitarism in pregnant women.

Causes and Risk Factors

The destruction of cells of the anterior pituitary gland due to oxygen starvation, mainly at the time of childbirth, is considered the leading cause of Sheehan’s syndrome. The presence of disseminated intravascular coagulation also appears to be a factor in the development of this condition. As the pituitary gland regulates the rest of your endocrine system, it is responsible for signalling other glands to hike up or lessen the production of the hormones that control vital processes like fertility, blood pressure, metabolism, breast milk production, among others. Hence if the pituitary gland fails to produce any of these hormones, they can cause different types of problems throughout the body. The pituitary gland consists of two lobes, the anterior lobe and the posterior lobe. The hormones produced by the anterior lobe that are affected by Sheehan’s syndrome are:

1. Prolactin

Prolactin hormone stimulates the production of breast milk.

2. Growth Hormone

This hormone regulates the growth of most cells in the body, including bone growth, and is responsible for maintaining muscle mass.

3. Thyroid-stimulating Hormone

This hormone stimulates the thyroid to produce the thyroxine and triiodothyronine hormones.

4. Follicle-stimulating Hormone and Luteinizing Hormones

These gonadotropin hormones regulate the functions of the ovaries for sexual reproduction.

5. Adrenocorticotropic Hormone

This hormone regulates the production of glucocorticoids like cortisol or stress hormone by the adrenal cortex.

6. Luteinizing Hormone (LH)

In women, LH stimulates estrogen that is responsible for ovulation.

Risk Factors

Any condition that increases the risk of haemorrhage or severe bleeding, or low blood pressure at the time of childbirth can increase the risk of Sheehan’s syndrome. The main risks are to women who are pregnant with multiple babies or have placental disorders like placenta accreta or placenta previa.

Symptoms of Sheehan’s Syndrome

The symptoms of Sheehan’s syndrome may vary from one person to the other and may not be detected early. In rarer and much more serious cases, the symptoms manifest themselves right after a child’s birth. Some of the common symptoms are:

• Dry skin
• Early ageing
• Fatigue
• Loss of axillary and pubic hair
• Wrinkles around the lips and the eyes
• Constipation
• Irregular menstruation or oligomenorrhea
• Thinning of the vaginal lining
• Weak muscle strength
• Weight gain/weight loss
• Loss of pigmentation
• Decreased libido (lack of interest in sex)
• Constipation
• Hot flashes
• Insulin sensitivity
• Inability to resume menstruation (amenorrhea)
• Low blood pressure
• Reduced breasts size
• Tachycardia or irregular or fast heartbeat
• Inability to lactate (milk is not produced, and the mother is not able to breastfeed)
• Diabetes insipidus (kidneys produce an abnormal amount of urine)

Complications

Since pituitary hormones control many aspects of our metabolism, Sheehan’s syndrome can cause complications that include:

• Irregularities in the menstrual cycle
• Adrenal crisis (adrenal glands release very less amount of the hormone cortisol)
• Unintended weight loss
• Low blood pressure

The most serious complication is the adrenal crisis, which usually occurs when our body is under extreme stress like surgery or any serious illness. During this time, adrenal glands produce too little of a powerful stress hormone (cortisol). This sudden and life-threatening state can further lead to extremely low blood pressure, coma, shock, or even death.

Diagnosis of Sheehan’s Syndrome

Diagnosing Sheehan’s syndrome can be difficult as most of its symptoms overlap with other conditions. A diagnosis of Sheehan’s syndrome is usually made through Sheehan syndrome lab tests, when a woman has symptoms of hypopituitarism and medical history of abnormal bleeding during childbirth. Diagnosis of Sheehan’s syndrome is mostly done by:

1. Medical History

It’s important to inform your doctor about any complications during childbirth, no matter how long ago you gave birth. Whether you faced any lactation problem or failed to begin menstruating after delivery which are the two key signs of Sheehan’s syndrome.

2. Blood Tests

Blood tests can be done for chronic cases to detect the levels of the pituitary gland or other hormones.

3. Pituitary Hormone Stimulation Test

Stimulation testing of the pituitary hormones involves injecting hormones and running repeated blood tests to determine the response of the pituitary glands. This test is typically done by endocrinologists who specialize in hormonal disorders.

4. Imaging Tests

Imaging tests, such as an MRI scan or CT scan, can check the size of your pituitary gland and look for other possible reasons for your symptoms, such as a pituitary tumour which is the primary cause of hypopituitarism and its attendant symptoms.

Treatment

Lifelong hormone replacement therapy is used to treat Sheehan’s syndrome just as regular hypopituitarism. In such a case, the hormone levels in the patient are evaluated to determine if a patient needs hormone replacement therapy, as this varies from one person to the other.

1. Estrogen and Progesterone

The doctor cannot evaluate these hormone levels until the age of menopause if they are still needed. In cases of removal of the uterus (hysterectomy), only estrogen will be prescribed, and a combination of estrogen and progesterone (if you still have your uterus) is given. Oral contraceptives are one of the common ways these hormones are replaced.

2. Thyroxine

Thyroxin is administered to replace the thyroid hormone. Levothyroxine is usually given to boost deficient thyroid hormone levels.

3. Cortisones Like Prednisone and Hydrocortisone

Corticosteroids are given to replace adrenocorticotropic hormones (ACTH).

4. Growth Hormone (GH)

The improvement of muscle to fat ratio, body mass index, and lowering of cholesterol levels can also make you feel better but may include joint pain and fluid retention.

Can It Be Prevented?

It is important to consult a doctor immediately if you have Sheehan’s syndrome as living with Sheehan’s syndrome untreated can be life-threatening. Hormone replacement therapies form the main basis of treatment as they are quite successful. For women who have Sheehan’s syndrome but wish to conceive, they should discuss their fertility options extensively with their gynaecologist or even consult a reproductive endocrinologist who specializes in fertility. Effective measures for the primary prevention of Sheehan’s can also be perinatal monitoring, prevention of pregnancy-related complications, maternal awareness about Sheehan’s syndrome and risk factors causing it, and post-puerperal follow-up.

With the development of science and improvements in obstetric practices, the frequency of Sheehan’s syndrome is certainly on the decline worldwide as it has become less common among women. But if you are affected by this condition, you must speak to your doctor and start with the treatment immediately!

Also Read:

Ways to Prepare for Childbirth
Interventions during Childbirth
How to Cope from Prodromal Labour