Sheehan's syndrome is damage to the pituitary gland due to complications during childbirth. The condition is triggered by heavy bleeding or very low blood pressure during or after delivery.
The pituitary gland or pituitary is a small gland located under the brain. The function of this gland is to produce hormones that control growth, production of thyroid hormone and cortisol hormone, milk production, menstrual cycle, and reproduction.
If the function of the pituitary gland is disturbed, the production of pituitary hormones will decrease. This can lead to a set of symptoms known as hypopituarism. This collection of symptoms is called Sheehan's syndrome if it occurs after delivery.
Causes of Sheehan's Syndrome
During pregnancy, the size of the pituitary gland will increase, especially in the few weeks before delivery. Therefore, at this time, the pituitary gland will need more nutrients and oxygen from the blood supply.
Sheehan's syndrome occurs when childbirth is followed by heavy bleeding or very low blood pressure. This condition can cause damage to the pituitary gland tissue, because this gland is in need of more blood flow. As a result, these glands are unable to function normally.
Sheehan's Syndrome Risk Factors
Any condition that can increase the risk of heavy bleeding or low blood pressure during pregnancy will automatically increase the risk of developing Sheehan's syndrome. A number of these conditions or factors are:
- placenta solution, namely the separation of the placenta from the uterine wall before the baby is born
- Placenta previa, which is a condition when part or all of the placenta covers the cervix
- Giving birth to a child weighing more than 4 kg or giving birth to twins
- Preeclampsia during pregnancy
- Delivery with the help of forceps or vacuum
Symptoms of Sheehan's Syndrome
Symptoms of Sheehan's syndrome generally appear slowly over months or even years. However, there are also symptoms that appear immediately, such as interruptions in breastfeeding. This depends on how severe the level of damage to the pituitary gland tissue is.
Symptoms that can appear in people with Sheehan syndrome include:
- Menstrual disorders, such as amenorrhea or oligomenorrhea
- Shaved hair doesn't grow anymore
- Low blood sugar level
- Little or no milk
- Wrinkles around the eyes and lips
- Breast shrink
- Weight gain
- Easy to get cold
- Decreased sexual desire
- Dry skin
- Body tired easily
- Decreased mental state
- Low blood pressure
- Heart rhythm disturbances or arrhythmias
- Joint pain
Symptoms of Sheehan's syndrome are often mistaken for other conditions, such as the normal fatigue that new mothers experience, and go undiagnosed. In this case, Sheehan's syndrome is usually only detected when there is an adrenal crisis, which is an emergency condition caused by low levels of the hormone cortisol in the body.
Diagnosis of Sheehan's Syndrome
To diagnose, the doctor will initially ask about the patient's medical history, especially a history of pregnancy complications, postpartum bleeding, not breastfeeding, or irregular menstruation after delivery.
After that, to confirm the diagnosis, the doctor will run blood tests to check the levels of hormones produced by the pituitary gland. The doctor will also perform a hormone stimulation test, namely by injecting hormones and seeing the response of the pituitary gland through several blood tests.
If needed, the doctor will also run imaging tests, such as a CT scan or MRI. This test aims to determine the size of the pituitary gland and rule out the possibility of complaints caused by other conditions, such as a pituitary tumor.
Sheehan's Syndrome Treatment
Sheehan's syndrome is treated with hormone replacement therapy. Some hormone replacements that doctors can give are:
- Corticosteroids, such as hydrocortisone and prednisone, to replace adrenal hormones that are not being produced, due to a deficiency of adrenocorticotropic hormone (ACTH)
- Levothyroxine, to treat thyroid hormone deficiency (hypothyroidism), due to low levels of thyroid-stimulating hormone (TSH)
- Estrogen (for patients who have undergone surgical removal of the uterus) or a combination of estrogen and progesterone (for patients who still have a uterus), to restore normal menstrual cycles
- Growth hormone, to lower cholesterol levels, maintain bone mass, normalize the ratio of muscle and body fat, and improve the overall quality of life of patients
Complications of Sheehan's Syndrome
Pituitary hormones play an important role in the body's metabolic functions. Therefore, disturbances in the production of pituitary hormones can cause complications such as:
- Low blood pressure
- Losing weight for no reason
- Menstrual cycle disorders
- Adrenal crisis, which is a medical emergency that can cause shock, loss of consciousness, and even coma
Sheehan's Syndrome Prevention
The risk of Sheehan's syndrome can be reduced by taking steps to prevent bleeding and low blood pressure during delivery. One of the ways to achieve this is by conducting regular prenatal check-ups and preparing for the birth process properly.
