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__NOTOC__
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{{Sheehan's syndrome}}
{{Sheehan's syndrome}}
{{CMG}}; {{AE}}  
{{CMG}}; {{AE}}{{IQ}}  
==Overview==
==Overview==
The majority of patients with [disease name] are asymptomatic.
The most common symptoms of [[Sheehan's syndrome|Sheehan's sydrome]] are including [[lactation]] failure and failure to resume [[menstruation]] after [[parturition]]. Common symptoms include [[hot flushes]], decreased [[Pubic|pubi]]<nowiki/>c/[[axillary]] hair, [[hypotension]], [[hypoglycemia]], features of [[hypothyroidism]], [[hypoadrenalism]], and [[hypogonadism]].
OR
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].


== History and Symptoms ==
== History and Symptoms ==
Clinical presentation in Sheehan's syndrome depends upon following factors:


'''(a) The onset'''
*[[Acute]]: Sudden onset of symptoms as seen in [[pituitary apoplexy]].
*[[Chronic]]: Slow onset, may take years to manifest.
'''(b) The severity of hormonal deficiency'''
*Complete [[hormonal]] deficiency: May present even in normal circumstances.
*Partial [[hormonal]] deficiency: May present only in times of [[stress]].
'''(c) The number of deficient hormones'''
*One [[hormone]] or some [[hormones]] are deficient ([[pituitary insufficiency]]/[[hypopituitarism]])
*All of the [[Pituitary hormone|pituitary hormones]] ([[panhypopituitarism]]).
Patients of [[Hypopituitarism (patient information)|hypopituitarism]] may be [[asymptomatic]] or show symptoms which can be nonspecific or specific for the deficient [[hormone]], such as an [[adrenal crisis]] or profound [[hypothyroidism]]. Patients can also present with symptoms suggestive of a [[mass]] lesion. [[Metastasis]] usually involves posterior [[Pituitary gland|pituitary]] initially thus presenting as [[diabetes insipidus]]. Patients with sellar [[mass]] may present with a [[headache]], [[diplopia]], or [[Vision loss|visual loss]].
===History===
===History===
Patients with Sheehan syndrome may have a positive history of:
Patients with Sheehan's syndrome may have a positive history of:
*Severe or massive [[PPH]]
*Severe or massive [[PPH|postpartum hemorrhage]] (PPH)
*Pituitary mass
*[[Pituitary]] mass
*[[Coagulopathy]] such as [[DIC]]
*[[Coagulopathy]], such as [[DIC|disseminated intravascular coagulation]] (DIC)


===Common Symptoms===
===Common Symptoms===
Common symptoms of Sheehan syndrome include:
Common symptoms of Sheehan's syndrome are including:
*Agalactorrhea due to mammary gland atrophy<ref name="urlSheehan Syndrome (Sheehans Syndrome) | SYMPTOMA.com">{{cite web |url=https://www.symptoma.com/en/info/sheehan-syndrome#epidemiology |title=Sheehan Syndrome (Sheehan's Syndrome) &#124; SYMPTOMA.com |format= |work= |accessdate=}}</ref>
*Agalactorrhea due to [[mammary gland]] [[atrophy]]<ref name="urlSheehan Syndrome (Sheehans Syndrome) | SYMPTOMA.com">{{cite web |url=https://www.symptoma.com/en/info/sheehan-syndrome#epidemiology |title=Sheehan Syndrome (Sheehan's Syndrome) &#124; SYMPTOMA.com |format= |work= |accessdate=}}</ref>
*Amenorrhea/oligomenorrhea
*[[Amenorrhea]]/[[oligomenorrhea]]
*Hot flushes
*Secondary [[infertility]]
*Decreased/absent pubic or axillary hair<ref name="pmid21041170">{{cite journal |vauthors=Gei-Guardia O, Soto-Herrera E, Gei-Brealey A, Chen-Ku CH |title=Sheehan syndrome in Costa Rica: clinical experience with 60 cases |journal=Endocr Pract |volume=17 |issue=3 |pages=337–44 |year=2011 |pmid=21041170 |doi=10.4158/EP10145.OR |url=}}</ref>
*[[Hot flushes]]
*Hypotension<ref name="pmid8557875">{{cite journal |vauthors=Kaufmann P, Lax SF, Radner H, Eber B, Leuger A, Smolle KH |title=Severe hypotension and coma secondary to unrecognized chronic anterior hypophysitis |journal=Intensive Care Med |volume=21 |issue=10 |pages=847–9 |year=1995 |pmid=8557875 |doi= |url=}}</ref>
*Decreased/absent [[pubic]] or [[axillary]] hair<ref name="pmid21041170">{{cite journal |vauthors=Gei-Guardia O, Soto-Herrera E, Gei-Brealey A, Chen-Ku CH |title=Sheehan syndrome in Costa Rica: clinical experience with 60 cases |journal=Endocr Pract |volume=17 |issue=3 |pages=337–44 |year=2011 |pmid=21041170 |doi=10.4158/EP10145.OR |url=}}</ref>
*Non-specific symptoms such as fatigue, weakness, and dizziness
*[[Hypotension]]<ref name="pmid8557875">{{cite journal |vauthors=Kaufmann P, Lax SF, Radner H, Eber B, Leuger A, Smolle KH |title=Severe hypotension and coma secondary to unrecognized chronic anterior hypophysitis |journal=Intensive Care Med |volume=21 |issue=10 |pages=847–9 |year=1995 |pmid=8557875 |doi= |url=}}</ref>
*Decreased libido
*Non-specific symptoms such as [[fatigue]], [[Muscle weakness|weakness]], [[anorexia]], [[malaise]], [[joint aches]], and [[dizziness]]
*Features of hypothyroidism, such as:<ref name="urlSheehan Syndrome (Sheehans Syndrome) | SYMPTOMA.com">{{cite web |url=https://www.symptoma.com/en/info/sheehan-syndrome#epidemiology |title=Sheehan Syndrome (Sheehan's Syndrome) &#124; SYMPTOMA.com |format= |work= |accessdate=}}</ref>
*Decreased [[libido]]
*Features of [[hypothyroidism]], such as:<ref name="urlSheehan Syndrome (Sheehans Syndrome) | SYMPTOMA.com">{{cite web |url=https://www.symptoma.com/en/info/sheehan-syndrome#epidemiology |title=Sheehan Syndrome (Sheehan's Syndrome) &#124; SYMPTOMA.com |format= |work= |accessdate=}}</ref>
**Dry skin
**Dry skin
**Cold intolerance
**Cold intolerance
**Constipation
**[[Constipation]]
**Bradycardia  
**[[Bradycardia]]
**Hair loss
**Hair loss
**Myxedema
*[[Vaginal atrophy]]
**Delayed reflexes
*Cognitive changes including [[psychosis]]<ref name="pmid23483784">{{cite journal |vauthors=Shoib S, Dar MM, Arif T, Bashir H, Bhat MH, Ahmed J |title=Sheehan's syndrome presenting as psychosis: a rare clinical presentation |journal=Med J Islam Repub Iran |volume=27 |issue=1 |pages=35–7 |year=2013 |pmid=23483784 |pmc=3592941 |doi= |url=}}</ref>
*Vaginal atrophy
*[[Osteopenia]] and [[osteoporosis]]<ref name="pmid26993664">{{cite journal |vauthors=Chihaoui M, Yazidi M, Chaker F, Belouidhnine M, Kanoun F, Lamine F, Ftouhi B, Sahli H, Slimane H |title=Bone Mineral Density in Sheehan's Syndrome; Prevalence of Low Bone Mass and Associated Factors |journal=J Clin Densitom |volume=19 |issue=4 |pages=413–418 |year=2016 |pmid=26993664 |doi=10.1016/j.jocd.2016.02.002 |url=}}</ref>
*Cognitive changes including psychosis<ref name="pmid23483784">{{cite journal |vauthors=Shoib S, Dar MM, Arif T, Bashir H, Bhat MH, Ahmed J |title=Sheehan's syndrome presenting as psychosis: a rare clinical presentation |journal=Med J Islam Repub Iran |volume=27 |issue=1 |pages=35–7 |year=2013 |pmid=23483784 |pmc=3592941 |doi= |url=}}</ref>
*[[Hypoglycemia]] and decreased [[insulin]] requirement in women with [[Diabetes mellitus type 1|Type 1 diabetes]]
*Osteopenia and osteoporosis<ref name="pmid26993664">{{cite journal |vauthors=Chihaoui M, Yazidi M, Chaker F, Belouidhnine M, Kanoun F, Lamine F, Ftouhi B, Sahli H, Slimane H |title=Bone Mineral Density in Sheehan's Syndrome; Prevalence of Low Bone Mass and Associated Factors |journal=J Clin Densitom |volume=19 |issue=4 |pages=413–418 |year=2016 |pmid=26993664 |doi=10.1016/j.jocd.2016.02.002 |url=}}</ref>
*Hypoglycemia and decreased insulin requirement in women with Type 1 Diabetes.
*Growth hormone deficiency
*Adrenal insufficiency causing asthenia, anorexia and weakness.


===Less Common Symptoms===
===Less Common Symptoms===
Less common symptoms of Sheehan syndrome include:
Less common symptoms of Sheehan's syndrome are including:
*Headache<ref name="pmid25223643">{{cite journal |vauthors=Hale B, Habib AS |title=Sheehan syndrome: acute presentation with severe headache |journal=Int J Obstet Anesth |volume=23 |issue=4 |pages=383–6 |year=2014 |pmid=25223643 |doi=10.1016/j.ijoa.2014.04.011 |url=}}</ref>
*[[Headache]]<ref name="pmid25223643">{{cite journal |vauthors=Hale B, Habib AS |title=Sheehan syndrome: acute presentation with severe headache |journal=Int J Obstet Anesth |volume=23 |issue=4 |pages=383–6 |year=2014 |pmid=25223643 |doi=10.1016/j.ijoa.2014.04.011 |url=}}</ref>
*Refractory hypotension<ref name="pmid28565814">{{cite journal |vauthors=Liang L, Liu JB, Chen FQ, Zhao J, Zhang XL |title=Refractory hypotension induced by Sheehan syndrome with pituitary crisis: A case report |journal=Exp Ther Med |volume=13 |issue=5 |pages=2097–2101 |year=2017 |pmid=28565814 |pmc=5443209 |doi=10.3892/etm.2017.4188 |url=}}</ref><ref name="pmid26113625">{{cite journal |vauthors=George A, Phillips M, Sweeney L, Colombo C |title=A 56 year old woman with syncope, weakness, and refractory hypotension |journal=BMJ |volume=350 |issue= |pages=h3387 |year=2015 |pmid=26113625 |doi= |url=}}</ref>
*Refractory [[hypotension]]<ref name="pmid28565814">{{cite journal |vauthors=Liang L, Liu JB, Chen FQ, Zhao J, Zhang XL |title=Refractory hypotension induced by Sheehan syndrome with pituitary crisis: A case report |journal=Exp Ther Med |volume=13 |issue=5 |pages=2097–2101 |year=2017 |pmid=28565814 |pmc=5443209 |doi=10.3892/etm.2017.4188 |url=}}</ref><ref name="pmid26113625">{{cite journal |vauthors=George A, Phillips M, Sweeney L, Colombo C |title=A 56 year old woman with syncope, weakness, and refractory hypotension |journal=BMJ |volume=350 |issue= |pages=h3387 |year=2015 |pmid=26113625 |doi= |url=}}</ref>
*Sinus sick syndrome and cardiac arrest<ref name="pmid28129900">{{cite journal |vauthors=Bouznad N, Mghari GE, Hattaoui ME, Ansari NE |title=[Atypical and rare cardiac revelation about Sheehan's syndrome: A report of three cases] |language=French |journal=Ann Cardiol Angeiol (Paris) |volume= |issue= |pages= |year=2017 |pmid=28129900 |doi=10.1016/j.ancard.2016.12.007 |url=}}</ref><ref name="pmid25332716">{{cite journal |vauthors=Zhao D, Zhang Q, Lu J, Zhang G, Lu H, Huang J, Shan Q |title=Sick sinus syndrome associated with hypopituitarism: a case report and literature review |journal=J Biomed Res |volume=28 |issue=5 |pages=429–32 |year=2014 |pmid=25332716 |pmc=4197395 |doi=10.7555/JBR.28.20130099 |url=}}</ref><ref name="pmid25275267">{{cite journal |vauthors=Cao L, Lu Z, Zheng Y |title=Sheehan's syndrome with cardiac arrest: a case report and review of the literature |journal=Neuro Endocrinol. Lett. |volume=35 |issue=5 |pages=352–4 |year=2014 |pmid=25275267 |doi= |url=}}</ref>
*[[Sick sinus syndrome|Sinus sick syndrome]] and [[cardiac arrest]]<ref name="pmid28129900">{{cite journal |vauthors=Bouznad N, Mghari GE, Hattaoui ME, Ansari NE |title=[Atypical and rare cardiac revelation about Sheehan's syndrome: A report of three cases] |language=French |journal=Ann Cardiol Angeiol (Paris) |volume= |issue= |pages= |year=2017 |pmid=28129900 |doi=10.1016/j.ancard.2016.12.007 |url=}}</ref><ref name="pmid25332716">{{cite journal |vauthors=Zhao D, Zhang Q, Lu J, Zhang G, Lu H, Huang J, Shan Q |title=Sick sinus syndrome associated with hypopituitarism: a case report and literature review |journal=J Biomed Res |volume=28 |issue=5 |pages=429–32 |year=2014 |pmid=25332716 |pmc=4197395 |doi=10.7555/JBR.28.20130099 |url=}}</ref><ref name="pmid25275267">{{cite journal |vauthors=Cao L, Lu Z, Zheng Y |title=Sheehan's syndrome with cardiac arrest: a case report and review of the literature |journal=Neuro Endocrinol. Lett. |volume=35 |issue=5 |pages=352–4 |year=2014 |pmid=25275267 |doi= |url=}}</ref>
*Generalized seizures due to hyponatremia.<ref name="pmid27034575">{{cite journal |vauthors=Parikh R, Buch V, Makwana M, Buch HN |title=The price of a 15-year delay in diagnosis of Sheehan's syndrome |journal=Proc (Bayl Univ Med Cent) |volume=29 |issue=2 |pages=212–3 |year=2016 |pmid=27034575 |pmc=4790577 |doi= |url=}}</ref>
*Generalized [[seizures]] due to [[hyponatremia]]<ref name="pmid27034575">{{cite journal |vauthors=Parikh R, Buch V, Makwana M, Buch HN |title=The price of a 15-year delay in diagnosis of Sheehan's syndrome |journal=Proc (Bayl Univ Med Cent) |volume=29 |issue=2 |pages=212–3 |year=2016 |pmid=27034575 |pmc=4790577 |doi= |url=}}</ref>
*Central diabetes insipidus.<ref name="pmid447511">{{cite journal |vauthors=Weiner P, Ben-Israel J, Plavnick L |title=Sheehan's syndrome with diabetes insipidus. A case study |journal=Isr. J. Med. Sci. |volume=15 |issue=5 |pages=431–3 |year=1979 |pmid=447511 |doi= |url=}}</ref><ref name="pmid424117">{{cite journal |vauthors=Collins ML, O'Brien P, Cline A |title=Diabetes insipidus following obstetric shock |journal=Obstet Gynecol |volume=53 |issue=3 Suppl |pages=16S–17S |year=1979 |pmid=424117 |doi= |url=}}</ref>
*[[Adrenal insufficiency]] causing [[asthenia]], [[anorexia]], and [[weakness]].
*Optic chiasm compression
 
** visual field loss
*[[Central diabetes insipidus]]<ref name="pmid447511">{{cite journal |vauthors=Weiner P, Ben-Israel J, Plavnick L |title=Sheehan's syndrome with diabetes insipidus. A case study |journal=Isr. J. Med. Sci. |volume=15 |issue=5 |pages=431–3 |year=1979 |pmid=447511 |doi= |url=}}</ref><ref name="pmid424117">{{cite journal |vauthors=Collins ML, O'Brien P, Cline A |title=Diabetes insipidus following obstetric shock |journal=Obstet Gynecol |volume=53 |issue=3 Suppl |pages=16S–17S |year=1979 |pmid=424117 |doi= |url=}}</ref><ref name="pmid17468192">{{cite journal |vauthors=Atmaca H, Tanriverdi F, Gokce C, Unluhizarci K, Kelestimur F |title=Posterior pituitary function in Sheehan's syndrome |journal=Eur. J. Endocrinol. |volume=156 |issue=5 |pages=563–7 |year=2007 |pmid=17468192 |doi=10.1530/EJE-06-0727 |url=}}</ref><ref name="pmid6693547">{{cite journal |vauthors=Bakiri F, Benmiloud M, Vallotton MB |title=Arginine-vasopressin in postpartum panhypopituitarism: urinary excretion and kidney response to osmolar load |journal=J. Clin. Endocrinol. Metab. |volume=58 |issue=3 |pages=511–5 |year=1984 |pmid=6693547 |doi=10.1210/jcem-58-3-511 |url=}}</ref><ref name="pmid3652485">{{cite journal |vauthors=Jialal I, Desai RK, Rajput MC |title=An assessment of posterior pituitary function in patients with Sheehan's syndrome |journal=Clin. Endocrinol. (Oxf) |volume=27 |issue=1 |pages=91–5 |year=1987 |pmid=3652485 |doi= |url=}}</ref>
** headache
*[[Optic chiasm]] compression
** ophthalmoplegia
** [[Visual field loss]]
** [[Headache]]
** [[Ophthalmoplegia]]
===Non-specific symptoms===
Patients with Sheehan's syndrome may present with the following non-specific [[symptoms]]:
{| class="wikitable"
!Acute hypopituitarism (days/weeks)
!Chronic hypopituitarism (months/years)
|-
|
*[[Headache]]
*[[Nausea]] and [[vomiting]]
*[[Visual impairment]]
*[[Fatigue (physical)|fatigue]]
*[[Cold]] intolerance
*[[Hypotension]]
*[[Dizziness]]
|
*[[Pallor]]
*[[Weight loss]]
*[[Anorexia]]
|}
===Symptoms of deficient hormones===
In Sheehan's syndrome, either one or a few of the [[pituitary gland]] [[hormones]] are decreased ([[hypopituitarism]]) or all of the hormones ([[panhypopituitarism]]) may be decreased. In this table, each hormone deficiency symptoms are listed.<ref name="FleseriuHashim2016">{{cite journal|last1=Fleseriu|first1=Maria|last2=Hashim|first2=Ibrahim A.|last3=Karavitaki|first3=Niki|last4=Melmed|first4=Shlomo|last5=Murad|first5=M. Hassan|last6=Salvatori|first6=Roberto|last7=Samuels|first7=Mary H.|title=Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline|journal=The Journal of Clinical Endocrinology & Metabolism|volume=101|issue=11|year=2016|pages=3888–3921|issn=0021-972X|doi=10.1210/jc.2016-2118}}</ref>
{| class="wikitable"
!Pituitary gland
!Hormone
!Symptoms of deficiency
|-
| rowspan="5" |'''Anterior pituitary'''
|[[Adrenocorticotropic hormone|Adrenocorticotrophic Hormone (ACTH)]]
|The most critical [[hormonal]] deficiency.<ref name="Burke1985">{{cite journal|last1=Burke|first1=C.W.|title=Adrenocortical insufficiency|journal=Clinics in Endocrinology and Metabolism|volume=14|issue=4|year=1985|pages=947–976|issn=0300595X|doi=10.1016/S0300-595X(85)80084-0}}</ref><ref name="pmid25098712">{{cite journal| author=Bancos I, Hahner S, Tomlinson J, Arlt W| title=Diagnosis and management of adrenal insufficiency. | journal=Lancet Diabetes Endocrinol | year= 2015 | volume= 3 | issue= 3 | pages= 216-26 | pmid=25098712 | doi=10.1016/S2213-8587(14)70142-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25098712  }}</ref>
*[[Nausea and vomiting]]
*[[Fatigue]]
*[[Abdominal pain]]
*[[Weight loss]]
*[[Chest pain]]
*[[Confusion]] ([[hypoglycemia]])
|-
|[[Growth hormone|Growth Hormone (GH)]]
|
*[[Fatigue]]
*Decreased tolerance of [[Physical exercise|exercise]]
*Decreased social functioning
*Increased [[cardiovascular]] risk
*Decrease [[muscle mass]]
*Decrease [[bone mineral density]] which may lead to [[osteoporosis]]<ref name="pmid15001597">{{cite journal| author=Murray RD, Columb B, Adams JE, Shalet SM| title=Low bone mass is an infrequent feature of the adult growth hormone deficiency syndrome in middle-age adults and the elderly. | journal=J Clin Endocrinol Metab | year= 2004 | volume= 89 | issue= 3 | pages= 1124-30 | pmid=15001597 | doi=10.1210/jc.2003-030685 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15001597  }}</ref>
|-
|[[Gonadotropin|Gonadotropin hormones:]]
*[[Luteinizing hormone|Luteinizing Hormone (LH)]]<ref name="pmid12050248">{{cite journal| author=Miller KK, Biller BM, Hier J, Arena E, Klibanski A| title=Androgens and bone density in women with hypopituitarism. | journal=J Clin Endocrinol Metab | year= 2002 | volume= 87 | issue= 6 | pages= 2770-6 | pmid=12050248 | doi=10.1210/jcem.87.6.8557 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12050248  }}</ref>
*[[FSH|Follicle Stimulating Hormone (FSH)]]
|
*[[Amenorrhea]]
*[[Oligomenorrhea]]
*[[Dyspareunia (patient information)|Dyspareunia]]
*[[Loss of libido|Decreased libido]]
*[[Hot flash|Hot flashes]]
*[[Vaginal]] dryness
*[[Infertility]]
|-
|[[Thyroid-stimulating hormone|Thyroid Stimulating Hormone (TSH)]]
|
*[[Constipation]]
*Cold intolerance
*[[Weight gain]]
*[[Dry skin]]
*[[Hoarseness]]
*[[Edema]]
*[[Depression]]
*[[Menorrhagia]]
*[[Arthralgia]]
*[[Psychomotor retardation]]
|-
|[[Prolactin]]
|
*[[Postpartum]] [[lactation]] failure
|-
| rowspan="2" |'''Posterior pituitary'''
|[[Oxytocin]]
|
*[[Muscle aches]]
*Decreased milk ejection during [[lactation]]
*[[Sleep disturbance]]
*[[Anxiety]]
|-
|[[Antidiuretic hormone|Antidiuretic hormone (ADH)]]
|
*[[Polyuria]]
*[[Polydipsia]]
*[[Nocturia]]
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
 
​
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Up-To-Date]]
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[[Category:Obstetrics]]

Latest revision as of 00:09, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Overview

The most common symptoms of Sheehan's sydrome are including lactation failure and failure to resume menstruation after parturition. Common symptoms include hot flushes, decreased pubic/axillary hair, hypotension, hypoglycemia, features of hypothyroidism, hypoadrenalism, and hypogonadism.

History and Symptoms

Clinical presentation in Sheehan's syndrome depends upon following factors:

(a) The onset

(b) The severity of hormonal deficiency

  • Complete hormonal deficiency: May present even in normal circumstances.
  • Partial hormonal deficiency: May present only in times of stress.

(c) The number of deficient hormones

Patients of hypopituitarism may be asymptomatic or show symptoms which can be nonspecific or specific for the deficient hormone, such as an adrenal crisis or profound hypothyroidism. Patients can also present with symptoms suggestive of a mass lesion. Metastasis usually involves posterior pituitary initially thus presenting as diabetes insipidus. Patients with sellar mass may present with a headache, diplopia, or visual loss.

History

Patients with Sheehan's syndrome may have a positive history of:

Common Symptoms

Common symptoms of Sheehan's syndrome are including:

Less Common Symptoms

Less common symptoms of Sheehan's syndrome are including:

Non-specific symptoms

Patients with Sheehan's syndrome may present with the following non-specific symptoms:

Acute hypopituitarism (days/weeks) Chronic hypopituitarism (months/years)

Symptoms of deficient hormones

In Sheehan's syndrome, either one or a few of the pituitary gland hormones are decreased (hypopituitarism) or all of the hormones (panhypopituitarism) may be decreased. In this table, each hormone deficiency symptoms are listed.[18]

Pituitary gland Hormone Symptoms of deficiency
Anterior pituitary Adrenocorticotrophic Hormone (ACTH) The most critical hormonal deficiency.[19][20]
Growth Hormone (GH)
Gonadotropin hormones:
Thyroid Stimulating Hormone (TSH)
Prolactin
Posterior pituitary Oxytocin
Antidiuretic hormone (ADH)

References

  1. ↑ 1.0 1.1 "Sheehan Syndrome (Sheehan's Syndrome) | SYMPTOMA.com".
  2. ↑ Gei-Guardia O, Soto-Herrera E, Gei-Brealey A, Chen-Ku CH (2011). "Sheehan syndrome in Costa Rica: clinical experience with 60 cases". Endocr Pract. 17 (3): 337–44. doi:10.4158/EP10145.OR. PMID 21041170.
  3. ↑ Kaufmann P, Lax SF, Radner H, Eber B, Leuger A, Smolle KH (1995). "Severe hypotension and coma secondary to unrecognized chronic anterior hypophysitis". Intensive Care Med. 21 (10): 847–9. PMID 8557875.
  4. ↑ Shoib S, Dar MM, Arif T, Bashir H, Bhat MH, Ahmed J (2013). "Sheehan's syndrome presenting as psychosis: a rare clinical presentation". Med J Islam Repub Iran. 27 (1): 35–7. PMC 3592941. PMID 23483784.
  5. ↑ Chihaoui M, Yazidi M, Chaker F, Belouidhnine M, Kanoun F, Lamine F, Ftouhi B, Sahli H, Slimane H (2016). "Bone Mineral Density in Sheehan's Syndrome; Prevalence of Low Bone Mass and Associated Factors". J Clin Densitom. 19 (4): 413–418. doi:10.1016/j.jocd.2016.02.002. PMID 26993664.
  6. ↑ Hale B, Habib AS (2014). "Sheehan syndrome: acute presentation with severe headache". Int J Obstet Anesth. 23 (4): 383–6. doi:10.1016/j.ijoa.2014.04.011. PMID 25223643.
  7. ↑ Liang L, Liu JB, Chen FQ, Zhao J, Zhang XL (2017). "Refractory hypotension induced by Sheehan syndrome with pituitary crisis: A case report". Exp Ther Med. 13 (5): 2097–2101. doi:10.3892/etm.2017.4188. PMC 5443209. PMID 28565814.
  8. ↑ George A, Phillips M, Sweeney L, Colombo C (2015). "A 56 year old woman with syncope, weakness, and refractory hypotension". BMJ. 350: h3387. PMID 26113625.
  9. ↑ Bouznad N, Mghari GE, Hattaoui ME, Ansari NE (2017). "[Atypical and rare cardiac revelation about Sheehan's syndrome: A report of three cases]". Ann Cardiol Angeiol (Paris) (in French). doi:10.1016/j.ancard.2016.12.007. PMID 28129900.
  10. ↑ Zhao D, Zhang Q, Lu J, Zhang G, Lu H, Huang J, Shan Q (2014). "Sick sinus syndrome associated with hypopituitarism: a case report and literature review". J Biomed Res. 28 (5): 429–32. doi:10.7555/JBR.28.20130099. PMC 4197395. PMID 25332716.
  11. ↑ Cao L, Lu Z, Zheng Y (2014). "Sheehan's syndrome with cardiac arrest: a case report and review of the literature". Neuro Endocrinol. Lett. 35 (5): 352–4. PMID 25275267.
  12. ↑ Parikh R, Buch V, Makwana M, Buch HN (2016). "The price of a 15-year delay in diagnosis of Sheehan's syndrome". Proc (Bayl Univ Med Cent). 29 (2): 212–3. PMC 4790577. PMID 27034575.
  13. ↑ Weiner P, Ben-Israel J, Plavnick L (1979). "Sheehan's syndrome with diabetes insipidus. A case study". Isr. J. Med. Sci. 15 (5): 431–3. PMID 447511.
  14. ↑ Collins ML, O'Brien P, Cline A (1979). "Diabetes insipidus following obstetric shock". Obstet Gynecol. 53 (3 Suppl): 16S–17S. PMID 424117.
  15. ↑ Atmaca H, Tanriverdi F, Gokce C, Unluhizarci K, Kelestimur F (2007). "Posterior pituitary function in Sheehan's syndrome". Eur. J. Endocrinol. 156 (5): 563–7. doi:10.1530/EJE-06-0727. PMID 17468192.
  16. ↑ Bakiri F, Benmiloud M, Vallotton MB (1984). "Arginine-vasopressin in postpartum panhypopituitarism: urinary excretion and kidney response to osmolar load". J. Clin. Endocrinol. Metab. 58 (3): 511–5. doi:10.1210/jcem-58-3-511. PMID 6693547.
  17. ↑ Jialal I, Desai RK, Rajput MC (1987). "An assessment of posterior pituitary function in patients with Sheehan's syndrome". Clin. Endocrinol. (Oxf). 27 (1): 91–5. PMID 3652485.
  18. ↑ Fleseriu, Maria; Hashim, Ibrahim A.; Karavitaki, Niki; Melmed, Shlomo; Murad, M. Hassan; Salvatori, Roberto; Samuels, Mary H. (2016). "Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 101 (11): 3888–3921. doi:10.1210/jc.2016-2118. ISSN 0021-972X.
  19. ↑ Burke, C.W. (1985). "Adrenocortical insufficiency". Clinics in Endocrinology and Metabolism. 14 (4): 947–976. doi:10.1016/S0300-595X(85)80084-0. ISSN 0300-595X.
  20. ↑ Bancos I, Hahner S, Tomlinson J, Arlt W (2015). "Diagnosis and management of adrenal insufficiency". Lancet Diabetes Endocrinol. 3 (3): 216–26. doi:10.1016/S2213-8587(14)70142-1. PMID 25098712.
  21. ↑ Murray RD, Columb B, Adams JE, Shalet SM (2004). "Low bone mass is an infrequent feature of the adult growth hormone deficiency syndrome in middle-age adults and the elderly". J Clin Endocrinol Metab. 89 (3): 1124–30. doi:10.1210/jc.2003-030685. PMID 15001597.
  22. ↑ Miller KK, Biller BM, Hier J, Arena E, Klibanski A (2002). "Androgens and bone density in women with hypopituitarism". J Clin Endocrinol Metab. 87 (6): 2770–6. doi:10.1210/jcem.87.6.8557. PMID 12050248.

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