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Sheehan Syndrome: An Analysis of Possible Aetiological Factors
Author(s) -
Ammini A.C.,
Mathur S.K.
Publication year - 1994
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1994.tb01103.x
Subject(s) - sheehan's syndrome , medicine , pediatrics , etiology , hypopituitarism , psychiatry
EDITORIAL COMMENT: This condition is rare but the message is clear. These cases require a high index of suspicion to allow diagnosis before the woman is in dire straits. In 1962 the editor visited Professor Sheehan in Liverpool to discuss follow‐up of women who had had haemorrhagic shock to seek cases of pituitary failure. Professor Sheehan said to write letters to all the women who had required intensive resuscitation, then discard the names of those who answered the letter, and start to search for the remainder! At that time women with undiagnosed pituitary necrosis descended the social scale and tended to lack the application to seek medical assistance. Fancy seeing 12 cases of Sheehan syndrome in 1 hospital within 2 years! The problem of diagnosis remains. In this series the mean time from delivery to diagnosis was 5 years. The Editorial Committee members are doubtful if the recommendation in the last sentence of the summary is realistic because there is no simple screening test available for diagnosis of pituitary necrosis at the postpartum visit. The editor arranged for histories of all women with panhypopituitarism seen in 3 major teaching hospitals in Melbourne to be reviewed. There were 43 cases and review of the histories showed that none were cases of postpartum pituitary necrosis although one endocrinologist stated that he had seen 1 case of Sheehan syndrome diagnosed in the past 10 years. Apparently gonadotropin and prolactin secretion are the first hormone deficiencies that show up and early testing should be directed towards patients with amenorrhoea and lactation failure. Summary: Clinical features and obstetric care factors of aetiological importance were analyzed in 12 cases of Sheehan syndrome seen during the years 1992–1993. Eight patients were from urban areas. Eight of them were multiparas. Half of the patients had had hospital deliveries. The average duration between the onset of symptoms and diagnosis was 5 years. Patients were misdiagnosed as having general debility, hypothyroidism or unexplained amenorrhoea. Amenorrhoea, lactation failure, loss of body hair and signs and symptoms suggestive of hypothyroidism were present in most cases. Sheehan syndrome could be diagnosed on clinical grounds in our patients. We recommend that all women with peripartum complications should be followed in a postpartum clinic for early evidence of hypopituitarism.