Sheehan’s Syndrome

Question 1

Sheehan’s Syndrome

Answer 1

Complication of post-partum haemorrhage, where the drop in circulating blood volume leads to avascular necrosis of the pituitary gland.

Question 2

Which part of the pituitary gland is affected by sheehans syndrome

Answer 2

Anterior pituitary gland

Question 3

Blood supply to the anterior pituitary gland

Answer 3

Hypothalamo-hypophyseal portal system

Question 4

Hormones release by the anterior pituitary gland

Answer 4

Thyroid-stimulating hormone (TSH)
Adrenocorticotropic hormone (ACTH)
Follicle-stimulating hormone (FSH)
Luteinising hormone (LH)
Growth hormone (GH)
Prolactin

Question 5

Presentation of Sheehans syndrome

Answer 5

Reduced lactation - lack of prolactin
Amenorrhea - lack of LH and FSH
Adrenal insufficiency and adrenal crisis, caused by low cortisol - lack of ACTH
Hypothyroidism with low thyroid hormones - lack of TSH

Question 6

Management of Sheehans syndrome

Answer 6

Specialist endocrinologist care

Replacement of hormones:

• Oestrogen and progesterone
• Hydrocortisone for adrenal insufficiency
• Levothyroxine for hypothyroidism
• Growth hormone

Question 7

Investigations for Sheehan’s syndrome

Answer 7

Bloods - FBC, U+Es, LFTs, CRP, TFTs, Cortisol, FSH and LH

MRI head