Sheehan syndrome

Definition

Pathogenesis

• The differentials named were postpartum anaemia with pale mucosa, sleep deprivation and postnatal depression.
• The answer sought was Sheehan syndrome.
• The underlying lesion is ischaemic necrosis of the anterior pituitary after severe blood loss.

• Sheehan syndrome (postpartum pituitary necrosis) is necrosis of anterior pituitary cells after severe postpartum haemorrhage with hypovolaemia and shock; it causes pituitary insufficiency of varying extent up to panhypopituitarism.

Occurrence & epidemiology

Epidemiology

• Thanks to improved obstetric care it has become much rarer in high-income countries, while in resource-limited countries it remains a significant cause of morbidity and mortality; it accounts for about 6–8% of all causes of hypopituitarism.

Aetiopathogenesis

Aetiology and pathogenesis

• The anterior pituitary enlarges physiologically during pregnancy; its low-flow portal system is particularly susceptible to infarction with hypotension.
• Usually only the anterior lobe is affected, sometimes also the posterior lobe; diabetes insipidus is rare.

Clinical features

Presentation

• The earliest and most typical sign is failure of lactation.
• Added to this are amenorrhoea, fatigue, cold intolerance, hypotension and loss of secondary body hair.
• The most dangerous component is secondary adrenal insufficiency, with the risk of an adrenal crisis.
• The course is often insidious, so the diagnosis is made months or years later.

Clinical features and complications

• The typical feature is failure of lactation after birth, together with fatigue and loss of pubic and axillary hair.
• TSH deficiency causes hypothyroidism with facial puffiness, a hoarse voice, bradycardia and cold intolerance, ACTH deficiency adrenal insufficiency with fatigue, hypotension and reduced stress tolerance; hyperpigmentation and hyperkalaemia are absent.
• Acutely after birth, headache, impaired consciousness, hypotension, hypoglycaemia, nausea, vomiting and hyponatraemia may occur; usually, however, symptoms are non-specific, so diagnosis is often delayed.

Diagnosis

• A history of severe peripartum haemorrhage is the key clue; the diagnosis is based on low pituitary hormones and their target hormones.
• Pituitary MRI typically shows an empty sella in the later course.

Keep learning in the app

Further reading (selection)

1. StatPearls: Sheehan Syndrome (NCBI Bookshelf)
2. MSD Manual Professional Edition: Generalized Hypopituitarism
3. Pituitary 2025: Sheehan syndrome – a current approach to a dormant disease (PMC, open access)
4. DocCheck Flexikon, Sheehan-Syndrom

Cross-references