Abstract
Sheehan's syndrome occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. It may be rarely seen without massive bleeding or after normal delivery. Improvement in obstetric care and availability of rapid blood transfusion coincided with a remarkable reduction in the frequency of Sheehan's syndrome particularly in western society. But it has recently been reported more often from well-developed countries. It is one of the most common causes of hypopituitarism in underdeveloped or developing countries. Enlargement of pituitary gland, small sella size, disseminated intravascular coagulation and autoimmunity have been suggested to play a role in the pathogenesis of Sheehan's syndrome in women who suffer from severe postpartum hemorrhage. The patients may seek medical advice because of various presentations ranging from non-specific symptoms to coma and the clinical manifestation may change from one patient to another. Failure of postpartum lactation and failure to resume menses after delivery are the most common presenting symptoms. Although a small percentage of patients with Sheehan's syndrome may cause abrupt onset severe hypopituitarism immediately after delivery, most patients have a mild disease and go undiagnosed and untreated for a long time. It may result in partial or panhypopituitarism and GH is one of the hormones lost earliest. The great majority of the patients has empty sella on CT or MRI. Lymphocytic hypophysitis should be kept in mind in differential diagnosis. In this review, the old and recent data regarding Sheehan's syndrome are presented.
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References
Sheehan HL. Postpartum necrosis of the anterior pituitary. J Pathol Bact 1937;45:189–214.
Glinski LK. Z. Kazuistyki zmian anatomo-patologicznych w przysada mozgowej. Przogl Lek 1913;52:13–14.
Simmonds M. Uber hypophysisschwund mit todlichem ausgang. Dtsch Med Wschr 1914;40:322–323.
Sheehan HL. Simmonds disease due to postpartum necrosis of the anterior pituitary following postpartum haemorrhage. Q J Med 1939;32:277–309.
Sheehan HL. The frequency of post-partum hypopituitarism. Obstet Gynaecol Br Commonw 1965;72:103–111.
Abs R, Bengtsson B-A, Hernberg-Stahl E, Monson JP, Tauber J-P, Wilton P, Wüster C. GH replacement in 1034 growth hormone deficient hypopituitary adults: Demographic and clinical characteristics, dosing and safety. Clin Endocrinol 1999;50:703–713.
Kovacs K. Sheehan syndrome. Lancet 2003;361:520–522.
Comte L. Contribution a l'etude de l'hypophse humaine. Doctoral thesis, Lausanne, Switzerland, 1898.
Erdheim J, Stumme E. Ñber die schwangerschaftsveranderung der hypophuse. Beitr Z Pathol Anat Allg Pathol 1909;46:1–132.
Goluboff LG, Ezrin C. Effect of pregnancy on the somatotroph and the prolactin cell of the human adenohypophysis. J Clin Endocrinol Metab 1969;29:1533–1538.
Molitch ME. Pituitary diseases in pregnancy. Semin Perinatol 1998;22:457–470.
Scheithauer BW, Sano T, Kovacs KT, Young WF, Ryan N, Randall RV. The pituitary gland in pregnancy: A clinicopathologic and immunohistochemical study of 69 cases. Mayo Clin Proc 1990;65:461–474.
Bergland RM, Ray BS, Torack RM. Anatomical variations in the pituitary gland and adjacent structures in 225 human autopsy cases. J Neurosurg 1968;28:93–99.
Gonzalez JG, Elizondo G, Saldivar D, Nanez H, Todd LE, Villarreal JZ. Pituitary gland growth during normal pregnancy: An in vivo study using magnetic rezonance imaging. Am J Med 1988;85:217–220.
Dejager S, Gerber S, Foubert L, Turpin G. Sheehan's syndrome: Differential diagnosis in the acute phase. J Intern Med 1998;244:261–266.
Daughaday WH. The anterior pituitary. In:Wilson JD, Foster DW, eds. Textbook of Endocrinology. Philadelphia: W.B. Saunders, 1985:568–613.
Roberts DM. Sheehan's syndrome. Am Fam Physician 1998;37:223–227.
Gupta D, Gaiha M, Mahajan R, Daga MK. Atypical presentation of Sheehan's syndrome without postpartum haemorrahage. J Assoc Physicians India 2001;49:386–387.
Sheehan HL, Davis JC. Pituitary necrosis. Br Med Bull 1968;24:59–70.
Goswami R, Kochupillai N, Crock PA, Jaleel A, Gupta N, Pituitary autoimmunity in patients with Sheehan's syndrome. J Clin Endocrinol Metab 2002;87:4137–4141.
Engelberth O, Jezkova Z. Autoantibodies in Sheehan' syndrome. Lancet 1965;i:1075 (Letter).
Nishiyama S, Takano T, Hidaka Y et al. Acase of postpartum hypopituitarism associated with empty sella: Possible relation to postpartum autoimmune hypophysitis. Endocr J 1993;40:431–438.
Patel MC, Guneratne N, Hag N et al. Peripartum hypopituitarism and lymphocytic hypophysitis. Q J Med 1995;88:571–580.
Otsuka F, Kageyama J, Ogura T, Hattori T, Makino H. Sheehan's syndrome of more than 30 years' duration: An endocrine and MRI studies of 6 cases. Endocr J 1998;45:451–458.
Sherif IH, Vanderley CM, Beshyah S, Bosain S. Sella size and contents in Sheehan's syndrome. Clin Endocrinol 1989;30:613–618.
Meador CK, Worrell JL. The sella turcicca in postpartum pituitary necrosis (Sheehan's syndrome). Ann Intern Med 1966;65:259–264.
Bakiri F, Bendib S-E, Maoui R, Bendib A, Benmiloud M. The sella turcica in Sheehan's syndrome: Computerized tomograpic study in 54 patients. J Endocrinol Invest 1991;14:193–196.
Fleckman AM, Schubart UK, Danziger A, Fleicher N. Empty sella of normal size in Sheehan's syndrome. Am J Med 1983;75:585–591.
Lust K, McIntyre HD, Morton A. Sheehan's syndrome-acute presentation with hyponatremia and headache. Aust N Z J Obstet Gynaecol 2001;41:348–351.
Yamauchi T, Yoshio N, Mizuguchi T, Negoro E, Kamitani N, Ueda T. Acute fatty liver of pregnancy complicated with anterior pituitary insufficiency. Intern Med 2001;40:1227–1231.
Piech JJ, Thieblot P, Haberer JP, Delatour M, Moinade S, Gaillard G. Twin pregnancy with hepatic steatosis followed by hypopituitarism and diabetes insipidus. Press Med 1985;14:1421–1423.
Lavallee G, Morcos R, Palardy J, Aube M, Gilbert D. MR of nonhemorrhagic postpartum pituitary apoplexy. Am J Neuroradiol 1995;16:1939–1941.
Vaphiades MS, Simmons D, Archer RL, Stringer W. Sheehan's syndrome: A splinter of the mind. Surv Ophtalmol 2003;48:230–233.
Huang Y.-Y, Ting M-K, Hsu BRS, Tsar J-S. Demonstration of reserved anterior pituitary function among patients with amenorrhea after postpartum hemorrhage. Gynecol Endocrinol 2000; 14:99–104.
Haddock L, Vega LA, Aguiló F, Rodriguez O. Adrenocortical, thyroidal and human growth hormone reserve in Sheehan's syndrome. Johns Hopkins Med Bull 1972;131:80–99.
Kelestimur F. GH deficiency and the degree of hypopituitarism. Clin Endocrinol 1995;42:443–444 (letter).
Jialal I, Naidee C, Norman RJ, Rajput MJ, Omar MA, Joubert SM. Pituitary function in Sheehan's syndrome. Obstet Gynecol 1984;63:15–19.
Shahmanesh M, Ali Z, Pourmand M, Nourmand I. Pituitary function tests in Sheehan's syndrome. Clin Endocrinol 1980;12:3003–311.
Kelestimur F, Auernhammer C, Colak R, Gomez JM, Molvahlar S, Goth MI. Clinical characteristics and response to GH replacement in Sheehan's syndrome and non-functioning pituitary adenoma-similarities and differences. 6th European Congress of Endocrinology. 26–30 April, 2003. Lyon, France. P1090 (Abstract).
Sheehan HL. Atypical hypopituitarism. Proc Royal Soc Med 1961;54:43–48.
Kelestimur F. Hyperprolactinemia in a patient with Sheehan's syndrome. Southern Med J 1992;85:1008–1010.
Stacpoole PW, Kandell TW, Fisher WR. Primary empty sella, hyperprolactinemia, and isolated ACTH deficiency after postpartum hemorrhage. Am J Med 1983;74:905–908.
Grimes HG, Brooks MH. Pregnancy in Sheehan's syndrome. Report of a case and review. Obstet Gynecol Surv 1980;35:481–488.
Sheehan HL, Murdoch R. Postpartum necrosis of the anterior pituitary. Effect of subsequent pregnancy. Lancet 1939;1:818–820.
ÇolakoGlu M, Erçal T, KarslioGlu I. Am J Med 1987;82:578 (letter).
Keleştimur F, Utaş C, Özbakir Ö. Pituitary-adrenocortical axis in panhypopituitarism due to Sheehan's syndrome. Turk J Med Biol Res 1994;4:1–5.
DiZerega G, Kletzky OA, Mishell DR. Diagnosis of Sheehan's syndrome using a sequential pituitary stimulation test. Am J Obstet Gynecol 1978;132:348–353.
Sheehan HL, Whithead R. The neurohypophysis in postpartum hypopituitarism. J Pathol Bacteriol 1963;85:145–169.
Whitehead R. The hypothalamus in postpartum hypopituitarism. J Pathol Bacteriol 1963;86:55–67.
Kan AKS, Calligerous D. A case report of Sheehan's syndrome presenting with diabetes insipidus. Aust NZ J Obstet Gynaecol 1998;38:224–226.
Arnaout MA, Ajlouni K. Plasma vasopressin responses in postpartum hypopituitarism: Impaired response to osmotic stimuli. Acta Endocrinol 1992;127:494–498.
Güven M, Bayram F, Güven K, Kelestimur F. Evaluation of patients admitted with hypoglycaemia to a teaching hospital in Central Anatolia. Postgrad Med J 2000;76:150–152.
Bunch TJ, Dunn WF, Basu A, Gosman RI. Hyponatremia and hypoglycemia in acute Sheehan's syndrome. Gynecol Endocrinol 2002;16:419–423.
Aono T, Minagawa J, Kinugasa T, Tanizawa O, Kurachi K. Response of pituitary LH and FSH to synthetic LH-releasing hormone in normal subjects and patients with Sheehan's syndrome. Am J Obstet Gynecol 1973;117:1046–1052.
Maccagnan P, Oliveira JHA, Castro V, Abucham J. Abnormal circadian rhythm and increased non-pulsatile secretion of thyrotrophin in Sheehan's syndrome. Clin Endocrinol 1999;51:439–447.
Abucham J, Castro V, Maccagnan P, Vieira JGH. Increased thyrotropin levels and loss of the nocturnal thyrotropin surge in Sheehan's syndrome. Clin Endocrinol 1997;47:515–522.
Oliveira JHA, Persani L, Beck-Peccoz P, Abucham J. Investigating the paradox of hypothyroidism and increased serum thyrotropin (TSH) levels in Sheehan's syndrome: Characterization of TSH carbohydrate content and bioactivity. J Clin Endocrinol Metab 2001;86:1694–1699.
Özbey N, Inanç S, Aral F, Azezli A, Orhan Y, Sencer E, Molvalilar S. Clinical and laboratory evaluation of 40 patients with Sheehan's syndrome. Isr J Med Sci 1994;30:826–829.
Haughton VM, Rosenbaum AE, Williams AL, Drayer B. Recognazing the empty sella by CT: The infundibulum sign. Am J Roentgenol 1981;136:293–295.
Dash RJ, Gupta V, Suri S. Sheehan's syndrome: Clinical profile, pituitary hormone responses and computed sellar tomography. Aust NZ J Med 1993;23:26–31.
Seager W. Tumor like lesions of the sellar region. In: Thapar K, Kovacs K, Scheithauer BW, Lloyd RV, eds. Diagnosis and Management of Pituitary Tumors. Totowa, New Jersey: Humana Press, 2001:449–460.
Hashimoto K, Takao T, Makino S. lymphocytic adenohypophysitis and lymphocytic infundibuloneurohypophysitis. Endocr J 1997;44:1–10.
Ishihara T, Hino M, Kurahachi H, Kobayashi H, Kajikawa M, Moridera K, Ikekubo K, Hattori N. Long-term clinical course of two cases of lymphocytic adenohypophysitis. Endocr J 1996;43:433–440.
Kelestimur F. Lymphocytic hypophysitis and autoimmune thyroid disease. J Endocrinol Invest 2000;23:339–340.
Ñnlühizarci K, Bayram F, Çolak R, Öztürk F, Selçuklu A, Durak AC, Kelestimur F. Distinc radiological and clinical appearance of lymphocytic hpophysitis. J Clin Endocrinol Metab 2001;86:1861–1864.
Kristof RA, Roost DV, Klingmüller D, Springer W, Schramm J. Lymphocytic hypophysitis: Non-invasive diagnosis and treatment by high dose methylprednisolone pulse therapy. J Neurol Neurosurg Psychiatry 1999;67:398–402.
Bayram F, Kelestimur F, Öztürk F, Selcüklu A, Patiroglu TE, Beyhan Z. Lymphocytic hypophysitis in a patient with Graves' disease. J Endocrinol Invest 1998;21:193–197.
Kelestimur F, Auernhammer C, Colak R, Gomez JM, Molvalilar S, Koltowska-Haggstrom M, Jonsson PJ, Goth MI. The baseline characteristics and the effects of GH replacement therapy in patients with Sheehan's syndrome as compared to non-functioning pituitary adenoma. The Endocrine Society's 85th Annual Meeting, Philadelphia, U.S.A. 2003. (Abstract).
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Keleştimur, F. Sheehan's Syndrome. Pituitary 6, 181–188 (2003). https://doi.org/10.1023/B:PITU.0000023425.20854.8e
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DOI: https://doi.org/10.1023/B:PITU.0000023425.20854.8e