Article Sidebar

Submitted
Apr 20, 2021
Published
Apr 20, 2021
Download
PDF
Statistic
Read Counter : 42 Download : 60

Main Article Content

Abstract

Sheehan's syndrome (SS) is postpartum hypopituitarism caused by necrosis of the pituitary gland. Sheehan’s syndrome, though rare, is still one of the commonest causes of hypopituitarism in developing countries like ours. The clinical presentation is variable with abrupt or insidiously developing pituitary insufficiency after a heavy intra-partum or postpartum haemorrhage. It is usually the result of severe hypotension or shock caused by massive haemorrhage during or after delivery. Patients with SS have varying degrees of anterior pituitary hormone deficiency. Its frequency is decreasing worldwide and it is a rare cause of hypopituitarism in developed countries owing to advances in obstetric care. However, it is still frequent in underdeveloped and developing countries. SS often evolves slowly and hence is diagnosed late. History of postpartum haemorrhage, failure to lactate and cessation of menses are important clues to the diagnosis. Basal hormone levels may be enough in patients with typical histories, but most of the patients need more detailed investigation including dynamic pituitary function tests. The presence of anti-pituitary antibodies (APAs) has been demonstrated in some patients with SS, suggesting that an autoimmune pituitary process could be involved in this syndrome.  Pituitary MRI and CT may also be helpful for the investigation. Treatment of SS includes replacement of deficient hormone and the early diagnosis and appropriate treatment are important to reduce morbidity and mortality of the patients.

Keywords

Sheehan's syndrome hypovolemia sella panhypopituitarism adenohypophysis Lactotrops hyperplasia anti-pituitary antibodies (APAs) hormone replacement therapy

Article Details

How to Cite
Jeeva James, Babin D Reejo, Dr (Sr). Molly Mathew, Ayshath Sunaira T. A, Kishor Jyothi T. S, Mohammed Mirshad C. M, Negha C. K, & Safeera K. P. (2021). Sheehan’s syndrome- A review and update. International Journal of Research in Pharmacology & Pharmacotherapeutics, 4(2), 147-157. https://doi.org/10.61096/ijrpp.v4.iss2.2015.147-157
Download Citation
Endnote/Zotero/Mendeley (RIS)
BibTeX

References

  1. [1] Kavithakrishna, P Singh, AB Pradhan. Atypical presentation of sheehan`s syndrome. Japi 2006;54:747 -748
  2. [2] Allen Foulad. Pituitary Gland Anatomy. Medscape 2013;article 1899167
  3. [3] Susenne Hiller, Sturmhofel and AndrzejBartke. The endocrine system an overview. Alcohol health and research world 1998; 22(3):153 -164
  4. [4] Zuleyha Karaca, Fahrettin Kelestimur. Pregnancy and other pituitary disorders (including GH deficiency). Best practice and research clinical endocrinology and metabolism 2011;25:897-910
  5. [5] David Fraunbauch. Sheehan’s Syndrome. Sweeney law firm. Fort Wayne. Indiana Personal Injury. Medical Malpractice Lawyers & Attorneys. Feb 2015
  6. [6] Dr.Yusuf Ozkan. Sheehan`s syndrome. Clinical and laboratory evaluation of 20 cases. Neuroendocrinology letters No-3 June 2005;26: 257-260
  7. [7] Ajay kumar Morani, Hemant Parmar and Mohannad Ibrahim. Teaching neuro images. Sequential MRI of the pituitary in Sheehan syndrome. American academy of neurology 2012; 78: e3
  8. [8] Shivaprasad. Sheehan`s syndrome: Newer advances. Indian journal of endocrinology and metabolism 2011 ;15 (3):S203 - S207
  9. [9] Hallgerdur Lind Kristj ansdottir, Sigrun Perla Bodvarsdottir and Helga Agusta Sigurjansdottir. Sheehan’s syndrome in modern times: a nationwide retrospective study in Iceland. European Journal of Endocrinology 2011;16:349-354
  10. [10] Karaca Z, Tanriverdi F, Unluhizarci K, Kelestimur F. Pregnancy and piuitary disorders. Eur J Endocrinol 2010 Jun;162(6):1167
  11. [11] S. Dejager, S.Gerber L. Foubert and G. Turpin. Sheehan`s syndrome; differential diagnosis in the acute phase. Journal of internal medicine 1998; 244: 261-266
  12. [12] Zargar AH, Singh B, Laway BA, Masoodi SR, Wani AI & Bashir MI. Epidemiologic aspects of postpartum pituitary hypofunction (Sheehan’s syndrome). Fertility and Sterility 2005;84:523-528.
  13. [13] Abs R, Bengtsson BA, Hernberg-Stahl E, Monson JP, Tauber JP, Wilton P &Wuster C. GH replacement in 1034 growth hormone deficient hypopituitary adults: demographic and clinical characteristics, dosing and safety. Clinical Endocrinology 1999;50:703-713.
  14. [14] Etuk SJ, Asuquo EE. Maternal mortality following post-partum haemorrhage in Calabar a 6-year review. West Afr J Med, 1997, 16(3):165-169.
  15. [15] Arunkumar R Pande, Amitkumar. Asthenia and Body Swelling in a Young Female. Indian journal of medical specialities 2010;1(2): 137-141
  16. [16] E. Sunil, D. Rajita, G. Rajagopal, P. Satish, V. Suresh, P. Laksmi, M.M. Suchitra, B.V. Phaneendra, Alok Sachan. Sheehan's syndrome: a single centre experience. J Clin Sci Res 2013;2:16- 21
  17. [17] Huan- Wen Chen,MD; Deng - Huang Su, MD; Huan- Wu Chen, MD; Chia -Hui Yang, MD; Ching - Chung Chang, MD, PhD. Abnormal Enlargement of PItuitary Gland during Pregnancy Remitted spontaneously after Delivery. Chang Gung Med j 2007;30:81-86
  18. [18] A Maria Theresa, V Uma. Sheehan`s syndrome: A Case Study. Indian Journal of surgical Nursing may 2013;2(2):11.
  19. [19] Annamaria De Bellis, Fahrettin Kelestimur, Antonio Agostino Sinisi, Giuseppe Ruocco, Gilda Tirelli Marina Battaglia, Giuseppe Bellastella, Giovanni Conzo, Fatih Tanriverdi, Kursad Unluhizarc, Antonio Bizzarr and. Antonio Bellastella. Anti-hypothalamus and anti-pituitary antibodies may contribute to perpetuate the hypopituitarism in patients with Sheehan`s syndrome. European Journal of Endocrinology 2008;158:147-152
  20. [20] Stephen Nussey and Saffron Whitehead. Endocrinology; An Integrated Approach, Chapter 7. The pituitary gland, St. George's Hospital Medical School, London, UK, BIOS Scientific Publishers; 2001
  21. [21] Fabio A Nascimento, Juliane Nery, Gustavo Lenci Marques, Felipe Dunil dos Santos’ Mauricio de Carvalho. A decade without diagnosis: Sheehan`s syndrome. Case reports in Clinical medicine 2013;2(8):490-493
  22. [22] Schrager S, Sabo L. Sheehan`s syndrome: a rare complication of post-partum hemorrhage. J Am Board Fam. Pract 2001;14(5):389–391.
  23. [23] BaiseTikir, ErolGoka, Makbule Cigdem Ayydemir, Sahin Gurkan. Psychotic disorder and Sheehan`s syndrome: Etiology or comorbidity?. A case report. Turkish Journal of Endocrinology 2014;1- 3
  24. [24] Dosi R V,Bhatt N R, Patell R D, Raj R R. Recurrent hypoglycaemia ; A well-known presentation of Sheehan`s syndrome. J Postgrad Med 2013; 59:318-320
  25. [25] Disease conditions, Sheehan`s syndrome. Mayo Clinic Family Health Book, 4th Edition
  26. [26] Sarina Schrager, MD, Laura Sabo. Sheehan Syndrome: A Rare Complication of Postpartum Hemorrhage. Journal of American board of family medicine 2001;14(5): 1-3
  27. [27] Dizerega G, Kletzki OA Mishell DR. Diagnosis of Sheehan's syndrome using a sequential pituitary stimulation test. Am J Obstet Gynecol 1978 Oct 15;132(4):348-53.
  28. [28] Debora Vieira Soares; Flavia Lucia Conceicao; Mario Vaisman. Clinical labortorial and therapeutics aspects of Sheehan`s syndrome. Arq Bras Endocrinol Metabol 2008;52(5):872-878
  29. [29] VK Summers, M.D, M.R.C.P. The diagnosis and treatment of Simmond`s disease. Postgrad Med J 1947 Sep; 23(263): 441-443
  30. [30] MnifFatma, Ellleuch Mouna, Rekik Nabila, Mnif Mouna, Charfi Nadia and Abid Mohamed. Sheehan`s syndrome with pancytopenia; a case report and review of the literature. Journal of medical case report 2011; 5: 490
  31. [31] Mehmood I Qadri, Mohsin Bin Mushtaq, Iram Qazi Sameena Yousuf, and Aaliya Rashid. Sheehan’s Syndrome Presenting as Major depressive Disorder. Iran J Med Sci. 2015 Jan; 40(1): 73-76
  32. [32] Bashir Ahmad Laway, Shahnaz Ahmad Mir, MohdIqbal Dar1, Abdul Hamid Zargar. Sheehan`s syndrome with central diabetes insipidus. Arq Bras EndocrinolMetab 2011; 55(2):171- 174
  33. [33] M S A Cooray, UdithaBulugahapitiya, D DRanasinghe. Seizures: a rare presentation of Sheehan’s syndrome. Sri Lanka Journal of Diabetes Endocrinology and Metabolism 2013;3: 88-90
  34. [34] Sarno A et al. The effect of Quinagolide and Cabergoline, two selective dopamine receptor type 2 agonist in the treatment of prolactinomas. clini endocrine 53(5): 544-550
  35. [35] Thomas M J, Iqbal A S. Sheehan`s syndrome with psychosis. J Asssoc Physicians India 1985; 33:175-6
  36. [36] D Arpaci, N Cuhaci1, F Saglam, R Ersoy, B Cakir. Sheehan’s syndrome co-existing with Graves’ disease. Nigerian Journal of Clinical Practice Sep-Oct 2014;17(5): 662 -665
  37. [37] Janice M Anderson M.D, Dunken Etches M.D, M.CL.SC. Prevention and Management of Post-partum Haemorrhage. Am Fam Physician 2007; 75:875-82
  38. [38] Yoshiki Sasai. Self-formation of functional adenohypophysis in three-dimensional culture. Japanese RIKEN Center for Developmental Biology. Nature. 09 November 2011