Sheehan Syndrome

Snapshot

• A 26-year-old woman, 5 days post vaginal delivery, presents to her child’s pediatrician with a complaint that she is unable to breast feed her child. History reveals a vaginal delivery complicated by postpartum hemorrhage.

Introduction

• Failure to lactate following postpartum hemorrhage  
  • result of pituitary infarction that occured as a result of hypovolemic shock
    • pituitary normally very enlarged during pregancy due ↑ lactotrophs
    • no corresponding ↑ blood supply
• hypopituitarism results in ↓ prolactin secretion

Presentation

•  Symptoms  
  • sudden cessation of lactation 
    • loss of prolactin
  • fatigue
    • loss of TSH
  • loss of pubic and axillary hair
    • loss of LH/FSH
• anorexia

Evaluation

• Only clinically significant cause of lower than normal serum prolactin levels