Sheehan's syndrome history and symptoms

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.

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.

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 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 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
  • Visual field loss
  • Headache
  • Ophthalmoplegia

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

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]

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