Sheehan's syndrome overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Historical Perspective
Postpartum ischemic pituitary necrosis was first reported about a century ago in Przeglad Lekarski by Leon Konrad Gliński, though it was named after Harold Sheehan. Postpartum ischemic pituitary necrosis is still one of the most common causes of hypopituitarism in developing countries but it's prevalence is decreased in developed countries because of improved obstetrical care. Mostly, PPH leading to severe hypotension or shock results in Sheehan's syndrome.[1]
Classification
Pathophysiology
Severe PPH leading to hypotension and ischemic necrosis of pituitary gland is the most common cause of Sheehan syndrome.[2] Apart from pituitary gland enlargement during and before parturition, vasospasm, thrombosis and compression of the hypophyseal arteries, autoimmunity, DIC and smaller size of sella are thought to play a contributing role in pathogenesis of sheehan Syndrome.[2] It is thought that tissue necrosis results in release of sequestered antigens, precipitating autoimmunity of the pituitary gland and hypopituitarism in Sheehan's syndrome.[3] Type 1 diabetes, pre-existinfg vascular diseases and known/unknown pituitary masses are associated with increased risk of developing Sheehan syndrome in pregnancy [4] In order to better understand the pathophsiology, we need to review the anatomy of blood supply to pituitary gland. Anterior pituitary does not have a direct blood supply and is supplied by hypophyseal portal system. The hypophyseal portal system is a fenestrated set of capillaries and allows rapid exchange of hormones between hypothalamus and anterior pituitary. Occlusions and other issues in the blood vessels of the hypophysial portal system can also cause complications in the exchange of hormones between the hypothalamus and the pituitary gland leading to hypopituitarism. It can result in varying levels of hypopituitarism and pituitary hormones are decreased in the order of GH followed by FSH/LH, ACTH and finally TSH. Posterior pituitary is less affected compared to anterior pituitary as it has direct arterial blood supply.
Causes
Differentiating ((Page name)) from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Sheehan syndrome, if left untreated lead to mitral regurgitation, pericardial effusion and diminished LVM.
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
CT scan
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
References
- ↑ Krysiak R, Okopień B (2015). "[Sheehan's syndrome--a forgotten disease with 100 years' history]". Prz. Lek. (in Polish). 72 (6): 313–20. PMID 26817341.
- ↑ 2.0 2.1 Keleştimur F, Chow YW, Pietranico R, Mukerji A, Wiesmann UN, DiDonato S, Herschkowitz NN, Voigt WG, Johnson CR, Moroi K, Sato T, Keleştimur F, Goswami R, Kochupillai N, Crock PA, Jaleel A, Gupta N, Wrightstone RN, Smith LL, Wilson JB, Vella F, Huisman TH, Marniemi J, Parkki MG, Ward CW, Stellwagen E, Babul J, Pogodina VV, Goswami R, Kochupillai N, Crock PA, Jaleel A, Gupta N, Schmoldt A, Benthe HF, Haberland G, Lyons HA, Thomas JS, Heurich AE, Shepherd DA, Wetmore SD, Mekler LB, Sealey JE, White RP, Laragh JH, Rubin AL, Makar AB, McMartin KE, Palese M, Tephly TR, Frankle RT, Makar AB, McMartin KE, Palese M, Tephly TR, Makar AB, McMartin KE, Palese M, Tephly TR, Makar AB, McMartin KE, Palese M, Tephly TR, Makar AB, McMartin KE, Palese M, Tephly TR, Frankle RT, Thornton JA, Harrison MJ, Stellwagen E, Babul J, Leroy M, Loas G, Perez-Diaz F, Schmoldt A, Benthe HF, Haberland G, Coller BS, Franza BR, Gralnick HR (2003). "Sheehan's syndrome". Pituitary. 6 (4): 181–8. doi:10.1210/jc.2001-020242. PMID 15237929.
- ↑ Goswami R, Kochupillai N, Crock PA, Jaleel A, Gupta N (2002). "Pituitary autoimmunity in patients with Sheehan's syndrome". J. Clin. Endocrinol. Metab. 87 (9): 4137–41. doi:10.1210/jc.2001-020242. PMID 12213861.
- ↑ Abourawi, F (2006). "Diabetes Mellitus and Pregnancy". Libyan Journal of Medicine. 1 (1): 28–41. doi:10.4176/060617. ISSN 1993-2820.