Sheehan Syndrome: Symptoms, Causes, Treatment

Reduced pituitary blood supply can disrupt signals controlling adrenal, thyroid and ovarian function and milk production. Hormones are not equally affected in everyone, and breastfeeding difficulty alone is not diagnostic.

Related reading: Recognizing postpartum hemorrhage.

Poor milk production, absent periods, fatigue, cold intolerance, dry skin or low blood pressure may occur. Illness or surgery may reveal previously unrecognized cortisol deficiency.

Pituitary injury from inadequate blood and oxygen around delivery causes the syndrome. Clinicians consider other pituitary disorders, particularly without a clear history of hemorrhage or shock.

Severe bleeding and shock around delivery are major risks. Not everyone experiencing them develops the syndrome, but this history remains relevant even many years later.

Testing assesses cortisol, thyroid function and other hormones as indicated, sometimes with stimulation tests and pituitary imaging. Thyroid-stimulating hormone alone cannot adequately assess central hypothyroidism.

An endocrinologist replaces deficient hormones, often long term. Cortisol deficiency must be assessed and treated before starting thyroid hormone when present. Sex-hormone or growth-hormone treatment depends on results, contraindications and pregnancy goals.

Adrenal crisis, low glucose or blood pressure, bone problems and fertility difficulties can occur. Regular review adjusts replacement and reduces under- or overtreatment.

Effective obstetric hemorrhage care and follow-up reduce risk. People with cortisol deficiency need sick-day and emergency instructions and medical identification. Replacement should not be abruptly stopped.