Sheehan syndrome

Last revised by Joshua Yap on 1 Dec 2022

Sheehan syndrome is a rare cause of pituitary apoplexy and hypopituitarism. It only occurs in postpartum females who experience large volume hemorrhage and hypovolemic shock, either during delivery or afterward with resultant necrosis of anterior pituitary cells 4.

Advances in obstetrical care mean Sheehan syndrome is rare in developed countries. The incidence in developing and low-income countries is as high as 5 in 100,000 births 5.

  • pituitary failure 1

    • may be silent and present with delayed hypopituitarism

    • agalactorrhoea

    • amenorrhea

    • oligomenorrhea

    • adrenal insufficiency

    • hyponatremia (diabetes insipidus) in the acute setting of extreme hypovolemia

    • hypothyroidism

    • growth hormone deficiency

  • optic chiasm compression

    • visual field loss

    • headache

    • ophthalmoplegia

Hyperplasia of pituitary cells, particularly lactotrophs, occurs in the weeks preceding delivery resulting in an increased metabolic demand without a concomitant increase in blood supply 4. The anterior pituitary bloody supply is under relatively low pressure making these cells susceptible to ischemia. Pregnancies complicated by hypovolemia secondary to postpartum hemorrhage may lead to pituitary infarction and necrosis 4.

The posterior pituitary has its blood supply under higher pressure and is not usually affected however diabetes insipidus may occur as a rare manifestation of Sheehan syndrome 4,5.

  • ring enhancement surrounding a low attenuation empty sella 2

  • early

    • enlarged pituitary, with low T1, high T2 homogenous signal

    • ring enhancement

  • late

The basis of treatment is lifelong replacement of deficient hormones. Anterior pituitary hormones are generally affected in the following order after necrosis; growth hormone, prolactin, follicle-stimulating hormone, luteinizing hormone, adrenocorticotropic hormone and then thyroid-stimulating hormone 5.

It is named after Harold Leeming Sheehan (1900-1988), a British pathologist who first described the syndrome in 1937 5.

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Case 1: pituitary apoplexy
    Drag here to reorder.
  • Case 2: pituitary apoplexy
    Drag here to reorder.
  • Case 3: pituitary apoplexy
    Drag here to reorder.
  • Case 4: pituitary apoplexy
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.