Sheehan syndrome is damage to the pituitary gland caused by severe blood loss and low blood pressure during or after childbirth. The gland, which grows larger in pregnancy, loses its blood supply, so hormone levels fall over days to years.
Key symptoms
- Unable to breastfeed because milk does not come in
- Periods do not return after birth
- Fatigue, weakness, cold intolerance and weight changes
- Dizziness, nausea and low blood pressure
- Loss of pubic and armpit hair
What you find on exam
- Low blood pressure and orthostatic changes
- Dry skin, slow reflexes and slow heart rate (hypothyroidism)
- Pale skin and thin body hair
- Small breasts after failed lactation
Tests
- Morning cortisol and ACTH; stimulation test if unclear
- Free T4 with TSH (TSH can be low or normal)
- Prolactin, FSH, LH, estradiol and IGF-1
- Sodium (often low) and glucose; pituitary MRI
Treatment basics
- Replace cortisol first with hydrocortisone, then thyroid hormone with levothyroxine
- Estrogen and progestin replacement until the usual age of menopause
- Stress doses of hydrocortisone during illness or surgery
- Medical alert ID and lifelong endocrine follow-up
Red flags
- Adrenal crisis: shock, vomiting, confusion
- Severe low sodium or low blood sugar
- Massive postpartum hemorrhage followed by no milk production
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.