Sheehan's syndrome history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Overview

The most common symptoms of Sheehan's sydrome are including lactation failure and failure to resume menstruation after parturition. Common symptoms include hot flushes, decreased pubic/axillary hair, hypotension, hypoglycemia, features of hypothyroidism, hypoadrenalism, and hypogonadism.

History and Symptoms

Clinical presentation in Sheehan's syndrome depends upon following factors:

(a) The onset

Acute: Sudden onset of symptoms as seen in pituitary apoplexy.
Chronic: Slow onset, may take years to manifest.

(b) The severity of hormonal deficiency

Complete hormonal deficiency: May present even in normal circumstances.
Partial hormonal deficiency: May present only in times of stress.

(c) The number of deficient hormones

One hormone or some hormones are deficient (pituitary insufficiency/hypopituitarism)
All of the pituitary hormones (panhypopituitarism).

Patients of hypopituitarism may be asymptomatic or show symptoms which can be nonspecific or specific for the deficient hormone, such as an adrenal crisis or profound hypothyroidism. Patients can also present with symptoms suggestive of a mass lesion. Metastasis usually involves posterior pituitary initially thus presenting as diabetes insipidus. Patients with sellar mass may present with a headache, diplopia, or visual loss.

History

Patients with Sheehan's syndrome may have a positive history of:

Severe or massive postpartum hemorrhage (PPH)
Pituitary mass
Coagulopathy, such as disseminated intravascular coagulation (DIC)

Common Symptoms

Common symptoms of Sheehan's syndrome are including:

Agalactorrhea due to mammary gland atrophy^[1]
Amenorrhea/oligomenorrhea
Secondary infertility
Hot flushes
Decreased/absent pubic or axillary hair^[2]
Hypotension^[3]
Non-specific symptoms such as fatigue, weakness, anorexia, malaise, joint aches, and dizziness
Decreased libido
Features of hypothyroidism, such as:^[1]
- Dry skin
- Cold intolerance
- Constipation
- Bradycardia
- Hair loss
Vaginal atrophy
Cognitive changes including psychosis^[4]
Osteopenia and osteoporosis^[5]
Hypoglycemia and decreased insulin requirement in women with Type 1 diabetes

Less Common Symptoms

Less common symptoms of Sheehan's syndrome are including:

Headache^[6]
Refractory hypotension^[7]^[8]
Sinus sick syndrome and cardiac arrest^[9]^[10]^[11]
Generalized seizures due to hyponatremia^[12]
Adrenal insufficiency causing asthenia, anorexia, and weakness.

Central diabetes insipidus^[13]^[14]^[15]^[16]^[17]
Optic chiasm compression

Non-specific symptoms

Patients with Sheehan's syndrome may present with the following non-specific symptoms:

Acute hypopituitarism (days/weeks)	Chronic hypopituitarism (months/years)
Headache Nausea and vomiting Visual impairment fatigue Cold intolerance Hypotension Dizziness	Pallor Weight loss Anorexia

Symptoms of deficient hormones

In Sheehan's syndrome, either one or a few of the pituitary gland hormones are decreased (hypopituitarism) or all of the hormones (panhypopituitarism) may be decreased. In this table, each hormone deficiency symptoms are listed.^[18]

Pituitary gland	Hormone	Symptoms of deficiency
Anterior pituitary	Adrenocorticotrophic Hormone (ACTH)	The most critical hormonal deficiency.^[19]^[20] Nausea and vomiting Fatigue Abdominal pain Weight loss Chest pain Confusion (hypoglycemia)
	Growth Hormone (GH)	Fatigue Decreased tolerance of exercise Decreased social functioning Increased cardiovascular risk Decrease muscle mass Decrease bone mineral density which may lead to osteoporosis^[21]
	Gonadotropin hormones: Luteinizing Hormone (LH)^[22] Follicle Stimulating Hormone (FSH)	Amenorrhea Oligomenorrhea Dyspareunia Decreased libido Hot flashes Vaginal dryness Infertility
	Thyroid Stimulating Hormone (TSH)	Constipation Cold intolerance Weight gain Dry skin Hoarseness Edema Depression Menorrhagia Arthralgia Psychomotor retardation
	Prolactin	Postpartum lactation failure
Posterior pituitary	Oxytocin	Muscle aches Decreased milk ejection during lactation Sleep disturbance Anxiety
Posterior pituitary	Antidiuretic hormone (ADH)	Polyuria Polydipsia Nocturia

References

↑ ^1.0 ^1.1 "Sheehan Syndrome (Sheehan's Syndrome) | SYMPTOMA.com".
↑ Gei-Guardia O, Soto-Herrera E, Gei-Brealey A, Chen-Ku CH (2011). "Sheehan syndrome in Costa Rica: clinical experience with 60 cases". Endocr Pract. 17 (3): 337–44. doi:10.4158/EP10145.OR. PMID 21041170.
↑ Kaufmann P, Lax SF, Radner H, Eber B, Leuger A, Smolle KH (1995). "Severe hypotension and coma secondary to unrecognized chronic anterior hypophysitis". Intensive Care Med. 21 (10): 847–9. PMID 8557875.
↑ Shoib S, Dar MM, Arif T, Bashir H, Bhat MH, Ahmed J (2013). "Sheehan's syndrome presenting as psychosis: a rare clinical presentation". Med J Islam Repub Iran. 27 (1): 35–7. PMC 3592941. PMID 23483784.
↑ Chihaoui M, Yazidi M, Chaker F, Belouidhnine M, Kanoun F, Lamine F, Ftouhi B, Sahli H, Slimane H (2016). "Bone Mineral Density in Sheehan's Syndrome; Prevalence of Low Bone Mass and Associated Factors". J Clin Densitom. 19 (4): 413–418. doi:10.1016/j.jocd.2016.02.002. PMID 26993664.
↑ Hale B, Habib AS (2014). "Sheehan syndrome: acute presentation with severe headache". Int J Obstet Anesth. 23 (4): 383–6. doi:10.1016/j.ijoa.2014.04.011. PMID 25223643.
↑ Liang L, Liu JB, Chen FQ, Zhao J, Zhang XL (2017). "Refractory hypotension induced by Sheehan syndrome with pituitary crisis: A case report". Exp Ther Med. 13 (5): 2097–2101. doi:10.3892/etm.2017.4188. PMC 5443209. PMID 28565814.
↑ George A, Phillips M, Sweeney L, Colombo C (2015). "A 56 year old woman with syncope, weakness, and refractory hypotension". BMJ. 350: h3387. PMID 26113625.
↑ Bouznad N, Mghari GE, Hattaoui ME, Ansari NE (2017). "[Atypical and rare cardiac revelation about Sheehan's syndrome: A report of three cases]". Ann Cardiol Angeiol (Paris) (in French). doi:10.1016/j.ancard.2016.12.007. PMID 28129900.
↑ Zhao D, Zhang Q, Lu J, Zhang G, Lu H, Huang J, Shan Q (2014). "Sick sinus syndrome associated with hypopituitarism: a case report and literature review". J Biomed Res. 28 (5): 429–32. doi:10.7555/JBR.28.20130099. PMC 4197395. PMID 25332716.
↑ Cao L, Lu Z, Zheng Y (2014). "Sheehan's syndrome with cardiac arrest: a case report and review of the literature". Neuro Endocrinol. Lett. 35 (5): 352–4. PMID 25275267.
↑ Parikh R, Buch V, Makwana M, Buch HN (2016). "The price of a 15-year delay in diagnosis of Sheehan's syndrome". Proc (Bayl Univ Med Cent). 29 (2): 212–3. PMC 4790577. PMID 27034575.
↑ Weiner P, Ben-Israel J, Plavnick L (1979). "Sheehan's syndrome with diabetes insipidus. A case study". Isr. J. Med. Sci. 15 (5): 431–3. PMID 447511.
↑ Collins ML, O'Brien P, Cline A (1979). "Diabetes insipidus following obstetric shock". Obstet Gynecol. 53 (3 Suppl): 16S–17S. PMID 424117.
↑ Atmaca H, Tanriverdi F, Gokce C, Unluhizarci K, Kelestimur F (2007). "Posterior pituitary function in Sheehan's syndrome". Eur. J. Endocrinol. 156 (5): 563–7. doi:10.1530/EJE-06-0727. PMID 17468192.
↑ Bakiri F, Benmiloud M, Vallotton MB (1984). "Arginine-vasopressin in postpartum panhypopituitarism: urinary excretion and kidney response to osmolar load". J. Clin. Endocrinol. Metab. 58 (3): 511–5. doi:10.1210/jcem-58-3-511. PMID 6693547.
↑ Jialal I, Desai RK, Rajput MC (1987). "An assessment of posterior pituitary function in patients with Sheehan's syndrome". Clin. Endocrinol. (Oxf). 27 (1): 91–5. PMID 3652485.
↑ Fleseriu, Maria; Hashim, Ibrahim A.; Karavitaki, Niki; Melmed, Shlomo; Murad, M. Hassan; Salvatori, Roberto; Samuels, Mary H. (2016). "Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 101 (11): 3888–3921. doi:10.1210/jc.2016-2118. ISSN 0021-972X.
↑ Burke, C.W. (1985). "Adrenocortical insufficiency". Clinics in Endocrinology and Metabolism. 14 (4): 947–976. doi:10.1016/S0300-595X(85)80084-0. ISSN 0300-595X.
↑ Bancos I, Hahner S, Tomlinson J, Arlt W (2015). "Diagnosis and management of adrenal insufficiency". Lancet Diabetes Endocrinol. 3 (3): 216–26. doi:10.1016/S2213-8587(14)70142-1. PMID 25098712.
↑ Murray RD, Columb B, Adams JE, Shalet SM (2004). "Low bone mass is an infrequent feature of the adult growth hormone deficiency syndrome in middle-age adults and the elderly". J Clin Endocrinol Metab. 89 (3): 1124–30. doi:10.1210/jc.2003-030685. PMID 15001597.
↑ Miller KK, Biller BM, Hier J, Arena E, Klibanski A (2002). "Androgens and bone density in women with hypopituitarism". J Clin Endocrinol Metab. 87 (6): 2770–6. doi:10.1210/jcem.87.6.8557. PMID 12050248.

Template:WH Template:WS

[urlSheehan_Syndrome_(Sheehans_Syndrome)_|_SYMPTOMA.com-1] 1.0 ^1.1 "Sheehan Syndrome (Sheehan's Syndrome) | SYMPTOMA.com".

[pmid21041170-2] Gei-Guardia O, Soto-Herrera E, Gei-Brealey A, Chen-Ku CH (2011). "Sheehan syndrome in Costa Rica: clinical experience with 60 cases". Endocr Pract. 17 (3): 337–44. doi:10.4158/EP10145.OR. PMID 21041170.

[pmid8557875-3] Kaufmann P, Lax SF, Radner H, Eber B, Leuger A, Smolle KH (1995). "Severe hypotension and coma secondary to unrecognized chronic anterior hypophysitis". Intensive Care Med. 21 (10): 847–9. PMID 8557875.

[pmid23483784-4] Shoib S, Dar MM, Arif T, Bashir H, Bhat MH, Ahmed J (2013). "Sheehan's syndrome presenting as psychosis: a rare clinical presentation". Med J Islam Repub Iran. 27 (1): 35–7. PMC 3592941. PMID 23483784.

[pmid26993664-5] Chihaoui M, Yazidi M, Chaker F, Belouidhnine M, Kanoun F, Lamine F, Ftouhi B, Sahli H, Slimane H (2016). "Bone Mineral Density in Sheehan's Syndrome; Prevalence of Low Bone Mass and Associated Factors". J Clin Densitom. 19 (4): 413–418. doi:10.1016/j.jocd.2016.02.002. PMID 26993664.

[pmid25223643-6] Hale B, Habib AS (2014). "Sheehan syndrome: acute presentation with severe headache". Int J Obstet Anesth. 23 (4): 383–6. doi:10.1016/j.ijoa.2014.04.011. PMID 25223643.

[pmid28565814-7] Liang L, Liu JB, Chen FQ, Zhao J, Zhang XL (2017). "Refractory hypotension induced by Sheehan syndrome with pituitary crisis: A case report". Exp Ther Med. 13 (5): 2097–2101. doi:10.3892/etm.2017.4188. PMC 5443209. PMID 28565814.

[pmid26113625-8] George A, Phillips M, Sweeney L, Colombo C (2015). "A 56 year old woman with syncope, weakness, and refractory hypotension". BMJ. 350: h3387. PMID 26113625.

[pmid28129900-9] Bouznad N, Mghari GE, Hattaoui ME, Ansari NE (2017). "[Atypical and rare cardiac revelation about Sheehan's syndrome: A report of three cases]". Ann Cardiol Angeiol (Paris) (in French). doi:10.1016/j.ancard.2016.12.007. PMID 28129900.

[pmid25332716-10] Zhao D, Zhang Q, Lu J, Zhang G, Lu H, Huang J, Shan Q (2014). "Sick sinus syndrome associated with hypopituitarism: a case report and literature review". J Biomed Res. 28 (5): 429–32. doi:10.7555/JBR.28.20130099. PMC 4197395. PMID 25332716.

[pmid25275267-11] Cao L, Lu Z, Zheng Y (2014). "Sheehan's syndrome with cardiac arrest: a case report and review of the literature". Neuro Endocrinol. Lett. 35 (5): 352–4. PMID 25275267.

[pmid27034575-12] Parikh R, Buch V, Makwana M, Buch HN (2016). "The price of a 15-year delay in diagnosis of Sheehan's syndrome". Proc (Bayl Univ Med Cent). 29 (2): 212–3. PMC 4790577. PMID 27034575.

[pmid447511-13] Weiner P, Ben-Israel J, Plavnick L (1979). "Sheehan's syndrome with diabetes insipidus. A case study". Isr. J. Med. Sci. 15 (5): 431–3. PMID 447511.

[pmid424117-14] Collins ML, O'Brien P, Cline A (1979). "Diabetes insipidus following obstetric shock". Obstet Gynecol. 53 (3 Suppl): 16S–17S. PMID 424117.

[pmid17468192-15] Atmaca H, Tanriverdi F, Gokce C, Unluhizarci K, Kelestimur F (2007). "Posterior pituitary function in Sheehan's syndrome". Eur. J. Endocrinol. 156 (5): 563–7. doi:10.1530/EJE-06-0727. PMID 17468192.

[pmid6693547-16] Bakiri F, Benmiloud M, Vallotton MB (1984). "Arginine-vasopressin in postpartum panhypopituitarism: urinary excretion and kidney response to osmolar load". J. Clin. Endocrinol. Metab. 58 (3): 511–5. doi:10.1210/jcem-58-3-511. PMID 6693547.

[pmid3652485-17] Jialal I, Desai RK, Rajput MC (1987). "An assessment of posterior pituitary function in patients with Sheehan's syndrome". Clin. Endocrinol. (Oxf). 27 (1): 91–5. PMID 3652485.

[FleseriuHashim2016-18] Fleseriu, Maria; Hashim, Ibrahim A.; Karavitaki, Niki; Melmed, Shlomo; Murad, M. Hassan; Salvatori, Roberto; Samuels, Mary H. (2016). "Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 101 (11): 3888–3921. doi:10.1210/jc.2016-2118. ISSN 0021-972X.

[Burke1985-19] Burke, C.W. (1985). "Adrenocortical insufficiency". Clinics in Endocrinology and Metabolism. 14 (4): 947–976. doi:10.1016/S0300-595X(85)80084-0. ISSN 0300-595X.

[pmid25098712-20] Bancos I, Hahner S, Tomlinson J, Arlt W (2015). "Diagnosis and management of adrenal insufficiency". Lancet Diabetes Endocrinol. 3 (3): 216–26. doi:10.1016/S2213-8587(14)70142-1. PMID 25098712.

[pmid15001597-21] Murray RD, Columb B, Adams JE, Shalet SM (2004). "Low bone mass is an infrequent feature of the adult growth hormone deficiency syndrome in middle-age adults and the elderly". J Clin Endocrinol Metab. 89 (3): 1124–30. doi:10.1210/jc.2003-030685. PMID 15001597.

[pmid12050248-22] Miller KK, Biller BM, Hier J, Arena E, Klibanski A (2002). "Androgens and bone density in women with hypopituitarism". J Clin Endocrinol Metab. 87 (6): 2770–6. doi:10.1210/jcem.87.6.8557. PMID 12050248.

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