What is Sheehan's Syndrome?

Postpartum pituitary necrosis (death of pituitary tissue) caused by severe blood loss and shock during or after childbirth. The pituitary enlarges during pregnancy, making it vulnerable to drops in blood pressure.

When does it happen?

Following a complicated delivery with massive hemorrhage (postpartum hemorrhage). It is rare in developed countries with good obstetric care but still common in areas with limited medical resources.

Classic Clue:

Failure to lactate after delivery. The new mother cannot produce breast milk because prolactin is absent.

Other Symptoms (develop gradually over time):

• No return of menstrual periods postpartum.
• Fatigue, weakness (from low cortisol and thyroid).
• Low blood pressure.
• Loss of pubic and axillary hair.

Diagnosis:

• History: Complicated delivery with heavy bleeding.
• Hormone Testing: Low levels of all anterior pituitary hormones (prolactin, LH, FSH, ACTH, TSH, GH).
• MRI: May show an empty sella.

Treatment:

• Lifelong Hormone Replacement: Hydrocortisone, levothyroxine, estrogen (if premenopausal).
• No treatment for prolactin (unless she wants to breastfeed a future baby).