What is Sheehan’s Syndrome?
In 1937, Dr Sheehan described damage to the pituitary caused by haemorrhage (blood loss) or hypovolemia (very low blood pressure) during and after childbirth.
This is where the condition “Sheehan’s Syndrome” comes from.
It occurs because the pituitary gland does not receive enough oxygenated blood to keep the cells within it alive. Dr Sheehan called this pituitary necrosis.
In more recent years, there have been calls for further research into this condition and whether there are other factors causing the damage.
Scientists believe there may also be a link to autoimmunity or having a small sized sella (the bony hollow that houses the pituitary) .
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Hormone Deficiencies
Women with Sheehan’s Syndrome have varying levels of pituitary hormone deficiencies requiring treatment through hormone replacement.
The most life-threatening deficiency is hypocorticolism (lack of the hormone cortisol). It is vital that this is detected and treated early to avoid risk of adrenal crisis.
This may present in the postpartum period or much later if a woman undergoes a stressor, such as an injury or surgery.
There is no clear link between the amount of blood loss and the level of hormone deficiencies.
Hormone deficiencies vary and depend on which cells have been damaged and to what extent.
You can find out more about hormone deficiencies here.
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Acute & Chronic Sheehan’s
Symptoms may appear in the initial postnatal period (acute) or over time (chronic) depending on the degree of tissue damage.
In acute Sheehan’s Syndrome, there may be illness or adrenal crisis in the early post-partum period if hypocorticolism is undetected.
In chronic Sheehan’s Syndrome, the onset of symptoms can be insidious, where a woman may feel generally unwell with unexplained fatigue.
Some mothers assume these symptoms are normal because they have a baby, but realise something isn’t right when their friends regain their pre-baby energy and start to exercise again.
Sheehan’s Syndrome is often overlooked because of improvements in obstetric care.
In our recent survey of 110 women, many reported they had been informed by healthcare professionals that Sheehan’s Syndrome no longer exists.
Some women find their symptoms are minimised or misunderstood. This can lead to symptoms being missed, along with delayed diagnosis and treatment.
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Time to diagnosis
In countries with more access to healthcare resources, the average time to diagnosis chronic Sheehan's Syndrome is 9 years.
In countries with less access to healthcare resources the average is 20 years [6].
You can find more information around seeking a diagnosis here.
Prevalence
We need more data on the prevalence of Sheehan’s Syndrome around the world.
In Iceland (a country with more access to healthcare resources) there was found to be a prevalence of 5.1 in 100,000 in 2011. The authors concluded that this figure was surprisingly high and also likely to be underestimated due to delayed or misdiagnosis .
In countries with less access to healthcare resources, such as India, the prevalence has been found to be 3,100 in 100,000.
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No Milk? Think Sheehan’s!
Regardless of acute or chronic presentation, the most frequently reported symptoms of Sheehan’s Syndrome are failure to produce breastmilk and lack of menstruation. You can find out more about our “No Milk? Think Sheehan’s!” awareness campaign here.
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