Sheehan's Syndrome: pathophysiology, diagnosis, and clinical management

Abstract

Sheehan's syndrome is a rare condition that occurs due to pituitary necrosis, often associated with severe postpartum hemorrhage. This syndrome is characterized by secondary pituitary insufficiency due to necrosis of the anterior pituitary gland, resulting in deficiencies of multiple pituitary hormones, such as adrenocorticotropic hormone (ACTH), growth hormone (GH), prolactin, gonadotropic hormones, and thyroid-stimulating hormone (TSH). Clinically, Sheehan's syndrome can manifest acutely or chronically, ranging from mild symptoms such as fatigue to severe presentations like hypovolemic shock. Common symptoms include amenorrhea, inability to breastfeed, hypoglycemia, hypotension, fatigue, anorexia, weight loss, and hyponatremia. The diagnosis is often challenging due to the insidious onset and variability of symptoms, with many cases being diagnosed years after the initial postpartum hemorrhage event. Diagnosis is based on clinical history, imaging tests such as magnetic resonance imaging (MRI), and hormonal tests that evaluate pituitary functions. Imaging tests like MRI are essential for visualizing alterations in the pituitary gland, and hormonal tests confirm hormonal deficiencies. Treatment involves continuous hormone replacement and symptom management to restore the patient's metabolic and endocrine homeostasis.