Updated: 8/6/2019

Sheehan Syndrome

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Topic
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Questions
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Evidence
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Snapshot
  • A 26-year-old woman, 5 days post vaginal delivery, presents to her child's pediatrician with a complaint that she is unable to breast feed her child. History reveals a vaginal delivery complicated by postpartum hemorrhage.
Introduction
  • Failure to lactate following postpartum hemorrhage  
    • result of pituitary infarction that occured as a result of hypovolemic shock
      • pituitary normally very enlarged during pregancy due ↑ lactotrophs
      • no corresponding ↑ blood supply
    • hypopituitarism results in ↓ prolactin secretion
Presentation
  •  Symptoms  
    • sudden cessation of lactation 
      • loss of prolactin
    • fatigue
      • loss of TSH
    • loss of pubic and axillary hair
      • loss of LH/FSH
    • anorexia
Evaluation
  • Only clinically significant cause of lower than normal serum prolactin levels 
 

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Questions (3)
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(M1.EC.17.4707) A 32-year-old female presents to her obstetrician 3 weeks postpartum for failure to lactate. Of note, she has been unable to tolerate cold environments since the birth of her child. Review of systems is positive for fatigue, lightheadedness, and a 3-pound weight gain over the last 3 weeks. Her delivery was complicated by placenta accreta with postpartum blood loss. Her newborn infant is doing well on formula. She denies any personal or family history of thyroid disease. Physical exam is overall unremarkable. On a panel of hormone testing, which of the following levels is most likely to be normal in this patient? Tested Concept

QID: 108430
1

Antidiuretic hormone

40%

(85/215)

2

Aldosterone

32%

(69/215)

3

Cortisol

8%

(17/215)

4

Luteinizing hormone

8%

(17/215)

5

Thyroid hormone

9%

(20/215)

M 1 C

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Evidence (7)
Topic COMMENTS (2)
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