Postpartum Hemorrhagic Hypopituitarism: Understanding its Causes, Symptoms, and Treatments; Focus on Sheehan Syndrome.
The pituitary gland, a vital endocrine organ located beneath the hypothalamus and within the sella turcica, undergoes significant changes during pregnancy. This growth is primarily attributed to the lactotrope cells, which increase in number and produce more prolactin hormone. As a result, the cross-sectional area and weight of the pituitary gland can increase by approximately 33%.
However, complications can arise during childbirth, leading to a rare condition known as Sheehan's syndrome. Named after Harold Leen Sheehan, a British pathologist who first introduced the concept of 'pregnancy-induced pituitary necrosis' in his 1937 paper, this syndrome is characterized by the death of cells in the anterior pituitary gland following postpartum hemorrhage and hypovolemia (low blood volume).
Factors that increase the risk of postpartum hemorrhage, such as multiple pregnancies, maternal blood disorders, macrosomia, placental abnormalities, soft tissue injury, preeclampsia, obesity, and insufficient obstetric care, also heighten the risk of developing Sheehan's syndrome.
Diagnosis of Sheehan's syndrome typically involves an MRI scan, along with a series of diagnostic tests including thyroid function tests, FSH, LH, prolactin, estrogen, cortisol, growth hormone tests, and a complete blood count. The syndrome can present with various symptoms such as insufficient lactation, hypotension, tachycardia, hyponatremia, and hypoglycemia. Additionally, it may cause hematological abnormalities such as normocytic/normochromic anemia, thrombocytopenia or pancytopenia, factor 8 and von Willebrand factor deficiency, and deficiencies in hormones such as thyroid hormones, growth hormone, prolactin, glucocorticosteroids, and gonadotropins.
While Sheehan's syndrome can present immediately following birth, patients may remain asymptomatic for months, even years, before being triggered by severe physical stress or severe infection.
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It's essential to raise awareness about Sheehan's syndrome to ensure timely diagnosis and treatment, and to reduce the risk of complications during childbirth. By supporting science communication, we can contribute to a better understanding of this condition and help improve the lives of those affected.
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