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Sheehan Syndrome (Postpartum Hypopituitarism, Detailed)

Pituitary necrosis caused by severe postpartum hemorrhage.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Endokrinoloji department. Book Appointment →

What is Sheehan Syndrome (Postpartum Hypopituitarism, Detailed)?

Sheehan syndrome is a postpartum hypopituitarism that develops after ischemic necrosis of the anterior pituitary gland (adenohypophysis) due to severe postpartum hemorrhage and hypovolemic shock. During pregnancy, the pituitary doubles in size due to lactotroph hyperplasia, becoming highly vulnerable to hypotension.

All anterior pituitary hormones (GH, LH/FSH, TSH, ACTH, prolactin) may be deficient. Hormones tend to be lost in a typical sequence: prolactin and GH are first, while ACTH is usually preserved longest. The posterior pituitary is generally spared, but transient diabetes insipidus may rarely occur.

Although classically presenting with failure to lactate and amenorrhea immediately postpartum, in mild cases diagnosis may be delayed for years (10-20 years). Signs of hypothyroidism, adrenal insufficiency, and infertility eventually develop. Diagnosis relies on hormone panels and pituitary MRI showing an empty sella.

Symptoms

Failure to lactate postpartum (agalactia)
Amenorrhea or oligomenorrhea
Severe fatigue, weakness
Cold intolerance, hypothyroidism findings
Hypotension, postural dizziness
Loss of axillary and pubic hair
Loss of libido
Hypoglycemia attacks
Pallor, anemia

Risk Factors

Severe postpartum hemorrhage
Hypovolemic shock
DIC (disseminated intravascular coagulation)
Placental abruption
Multiple pregnancy, polyhydramnios
Cesarean section with massive bleeding
Thrombocytopenia, coagulation disorders
Small pituitary fossa (anatomic risk)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Failure of milk production after delivery
  • Persistent menstrual irregularity postpartum
  • Severe fatigue and inability to perform daily activities
  • Postural hypotension and recurrent syncope
  • Unexplained hypoglycemia attacks
  • Inability to conceive again

Treatment Methods

01
Pituitary hormone panel (prolactin, FSH/LH, TSH, free T4, ACTH, cortisol, IGF-1)
02
Pituitary MRI (empty sella appearance)
03
Lifelong hormone replacement therapy
04
Hydrocortisone 15-20 mg/day (must be started first)
05
Levothyroxine (after cortisol replacement)
06
Estrogen-progesterone replacement
07
Growth hormone replacement (selected cases)
08
Stress-dose steroid in stress conditions
09
Endocrinology follow-up every 6 months

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.