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Hormone disorders
Published in Steve Hannigan, Inherited Metabolic Diseases: A Guide to 100 Conditions, 2018
This disorder may be caused by tumours of the pituitary gland or hypothalamus. It may also be caused by brain tumours, brain surgery, injury to the head, radiation, stroke, or an infection of the brain and its supporting tissues. In some cases, metabolic disorders or immune system diseases may cause hypopituitarism. This disorder may also be a complication following pregnancy (Sheehan’s syndrome).
Examination A
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, The New DRCOG Examination, 2017
Aalia Khan, Ramsey Jabbour, Almas Rehman
The most common cause is uterine atony (90%); other causes include retained placenta, soft tissue laceration, uterine inversion and coagulation disorder (e.g. von Willebrand’s disease). Sheehan’s syndrome is pituitary infarction (usually anterior but rarely posterior as well) due to severe obstetric shock and PPH occurring in approximately 1 in 10000 pregnancies.
Pregnancy and Sex-Related Deaths
Published in John M. Wayne, Cynthia A. Schandl, S. Erin Presnell, Forensic Pathology Review, 2017
John M. Wayne, Cynthia A. Schandl, S. Erin Presnell
Answer E is correct. Sheehan syndrome is defined as pituitary necrosis with a degree of failure occurring in the setting of pregnancy and is more common when significant blood loss occurs around the time of delivery. The pituitary gland is at risk of necrosis from abrupt decrease in blood pressure more so in association with pregnancy since it is enlarged. Such necrosis may be an incidental finding at autopsy depending on the extent of necrosis or may be the cause of death from acute panhypopituitarism.
Not so sweet diabetes: a rare case of postpartum central diabetes insipidus
Published in Journal of Obstetrics and Gynaecology, 2022
Xi May Zhen, Kirby Wong, Amelia Fernandes, Anne-Maree Kean
Sheehan’s syndrome, pituitary apoplexy with underlying adenoma, lymphocytic hypophysitis, and IgG4-related hypophysitis were considered unlikely in this case given the lack of suggestive features on high quality MRI of the pituitary, normal lactation, lack of anterior pituitary hormone insufficiency, and normal IgG4 levels. Another important consideration is transient gestational DI which is mostly attributed to excess vasopressinase activity (produced by placental trophoblasts) which metabolises AVP (Schrier 2010). Vasopressinase is produced from around 4–8 weeks of gestation with concentrations rising and peaking in the third trimester (Durr and Lindheimer 1996; Schrier 2010). In patients with normal AVP secretory reserve, the central release of AVP is increased in parallel with increased vasopressinase activity to maintain adequate water reabsorption and normal serum sodium levels (Schrier 2010). Vasopressinase levels fall following delivery with previous small studies suggesting that the plasma enzyme activity of vasopressinase became very low by 5–6 weeks postpartum and undetectable by 12 weeks postpartum (Davison et al. 1993). Correspondingly, most cases of transient gestational DI resolve by 5-6 weeks postpartum (Marques et al. 2015). However, our patient continues to require DDAVP at more than 20 weeks postpartum.
Sheehan’s syndrome as a mimic of premature ovarian insufficiency: need for advocacy
Published in Climacteric, 2021
S. Kalra, A. Dhingra, S. K. Sharma, S. Bhattacharya
Sheehan’s syndrome is a variant of ovarian insufficiency that shares many similarities with POI. During pregnancy, the pituitary gland enlarges and becomes susceptible to vascular damage from postpartum hemorrhagic shock. The resultant ischemic necrosis of the anterior pituitary, with various hormone secretory defects, is known as Sheehan’s syndrome [3]. Lactational failure due to prolactin deficiency is often the first indicator of Sheehan’s syndrome. Failure of resumption of menses after delivery is another frequent manifestation [4]. Thus, secondary amenorrhea is a key component of both Sheehan’s syndrome and POI. Gonadal hormone replacement should be offered to women in the reproductive age group for both conditions. Women with Sheehan’s syndrome may require additional hormonal replacement, as may women with autoimmune POI and multiglandular insufficiency.
Sheehan’s syndrome and sickle cell disease: the story of Natasha*
Published in Neuropsychological Rehabilitation, 2018
Barbara A. Wilson, Anita Rose, Gerhard Florschutz
Sheehan’s syndrome (SS) is one of the pituitary disorders. The pituitary gland at the base of the brain secretes eight hormones. There is a decrease in the secretion of one or more of these in people with SS. The syndrome is usually caused by a severe loss of blood during or after childbirth leading to decreased functioning of the pituitary gland. The syndrome was named after the British pathologist, Harold Leeming Sheehan, who, in 1937, described a specific association with postpartum shock or haemorrhage and necrosis of the pituitary gland. Although rare in countries with good obstetric care, SS is still frequent in those countries with poor healthcare services. Diri et al. (2014) say that it is a common cause of hypopituitarism in underdeveloped or developing countries. Kelestimur et al. (2005) in a study of 91 patients found that there were 12 cases in the UK and three in the USA. In comparison with patients whose pituitary dysfunction was due to a benign tumour, those with SS tended to be younger and have a poorer quality of life. For a recent discussion about the prevalence of SS see Diri, Karaca, Tanriverdi, Unluhizarci, and Kelestimur (2016). They say that the prevalence of SS is difficult to estimate because there are so many undiagnosed patients. Sheehan, himself, in 1965 estimated the worldwide prevalence was 100–200 per 100,000 women. Although this may have since decreased because of better obstetric care, the frequency of home birth is still high in some regions of the world making SS a frequent problem in under-resourced countries.