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Sheehan's syndrome
Etiology:
- pituitary apoplexy in the setting of complicated labor & delivery.
- generally associated with obstetric hemorrhage & hypotension
Clinical manifestations:
1) failure of post-partum lactation
2) amenorrhea, failure to resume menses
3) increasing fatigue & cold intolerance
4) acute adrenal insufficiency
- hypotension NOT responsive to volume replacement & pressors
Laboratory:
- see hypopitutarism & adrenal insufficiency
Complications:
- central adrenal insufficiency is the primary cause of mortality
- secondary hypothyroidism
Radiology:
- CT or MRI to view the sella turcica
Management:
- hydrocortisone
General
pituitary apoplexy
syndrome
pregnancy disorder; obstetric disorder; pregnancy complication
References
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 389
- Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 18.
American College of Physicians, Philadelphia 1998, 2012, 2018.
- Kristjansdottir HL, Bodvarsdottir SP, Sigurjonsdottir HA.
Sheehan's syndrome in modern times: a nationwide retrospective
study in Iceland.
Eur J Endocrinol. 2011 Mar;164(3):349-54. doi: 10.1530/EJE-10-1004
PMID: 21183555