Sheehan's Syndrome ( postpartum pituitary infarction , postpartum pituitary necrosis ) - occurs in cases of complication of the birth act with massive bleeding with the development of arterial hypotension . During pregnancy, the size of the pituitary gland increases, but its blood supply does not increase. Against the background of arterial hypotension developed as a result of postpartum hemorrhage, the pituitary blood supply decreases sharply - hypoxia and pituitary necrosis develop. The whole adenohypophysis ( hypopituitarism ) may be involved in the process, but it is lactotrophic cells that are most often damaged. Due to the absence of prolactin, lactation ceases - breastfeeding becomes impossible [1] . Sheehan syndrome is the second most common cause of hypopituitarism in adults.
| Sheehan syndrome | |
|---|---|
| ICD-10 | E 23.0 |
| ICD-10-KM | |
| ICD-9 | 253.2 |
| Diseasesdb | 11998 |
| Medlineplus | 001175 |
| eMedicine | med / 1914 |
| Mesh | D007018 |
Content
Etiology and pathogenesis
Hypovolemia during childbirth (as a result of massive blood loss) leads to a decrease in blood flow in an already enlarged pituitary gland . This leads to vasoconstriction and subsequent glandular infarction ( white heart attack with coagulation necrosis). The first symptom is a sharp cessation of lactation , since acidophilic cells producing prolactin will prevail at this time. After several months, other symptoms of hypopituitarism appear (for example, secondary amenorrhea due to a deficiency of gonadotropins ).
Epidemiology
Panhypopituitarism is much more likely to develop in women of young and middle age (20β40 years), however, individual cases of the disease are known both at an earlier and an older age [2] . The development of Sheehan syndrome in a girl of 12 years after juvenile uterine bleeding is described [3] .
Clinical picture
The clinical picture is very variable and consists of specific symptoms of hormonal deficiency and polymorphic neurovegetative manifestations. The severity and nature of the course of the disease (fast or gradual) is largely determined by the degree of decrease in adrenal function. Severe hypocorticism reduces patients' resistance to intercurrent infections and various stressful situations [2] .
Diagnostics
In typical cases, the diagnosis is simple. Timely diagnosis is delayed in patients with sluggish Sheehan's syndrome, although the absence of lactation after childbirth , accompanied by hemorrhage , a long-term decrease in working capacity and menstrual dysfunction should suggest hypopituitarism [2] .
Treatment
It should be aimed at compensating for hormonal insufficiency of the hypothalamic-pituitary system. In clinical practice, mainly hormonal preparations of peripheral endocrine glands and, to a lesser extent, tropic hormones of the pituitary gland due to their absence or high cost, are used. A significant obstacle to the use of pituitary hormone preparations is the rapid development of refractoriness to them due to an increase in antibody levels [2] .
There are two approaches to the treatment of Sheehan's Syndrome: hormone replacement therapy and the use of symptomatic drugs. It must be remembered that treatment of Sheehan's Syndrome at home is strictly prohibited. You canβt try any folk recipes, take medicine without knowing what it is, and generally self-medicate.
Notes
- β Endocrinology / Ed. N. Avalanche. - 2nd ed. Per. from English - M .: Practice, 1999 .-- S. 94, 166. - 1128 p. - 10,000 copies. - ISBN 5-89816-018-3 .
- β 1 2 3 4 Clinical endocrinology. Leadership / Ed. N.T. Starkova. - 3rd ed., Revised. and add. - SPb. : Peter, 2002 .-- pp. 111-118. - 576 p. - ("Doctor's Companion"). - 4000 copies. - ISBN 5-272-00314-4 .
- β Kayusheva I.V., Romankova M.G. Case of Shihan syndrome in a girl // Vopr. Ohr mat. - 1976. - T. 21, No. 8. - S. 87-88.