CASE STUDY OF TWO SUCCESSFUL PREGNANCIES IN SHEEHAN'S SYNDROME

Kaivan Patel, Vivek Patel, Abhijit S Pandya, Mirjana Pavlovic

Abstract


Sheehan’s syndrome (SS) is postpartum hypopituitarism which is caused by the ischemic necrosis of the anterior pituitary gland. It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery. Patients with this disorder have varying degrees of anterior pituitary hormone deficiency. In rare cases it may occur in posterior pituitary.

Its frequency is decreasing worldwide and it is a rare case of hypopituitarism in developed countries owing to advances in obstetric care.

However, it is still frequent in the underdeveloped and developing countries like India, especially the Northern states. As this disorder evolves slowly, it is often diagnosed late. History of postpartum hemorrhage, cessation of menses and failure to lactate are some important clues to diagnosis. Early diagnosis and appropriate treatment are important for the reduction in the mortality and morbidity of the patients. We report an unusual case of a 34-year-old female who had two normal deliveries while her underlying Sheehan syndrome remained undiagnosed. The woman presented hypothyroidism and severe headaches during her visit to our clinic and was later found to be suffering from Sheehan’s syndrome. She was diagnosed as having Sheehan’s syndrome by clinical manifestations, laboratory tests and MRI.

Detailed endocrinological studies were performed after patient complained of amenorrhea (failure to have normal periods).  In addition to these studies, a critical review of the literature was undertaken to more clearly define the clinical and laboratory features of pregnancy in Sheehan's syndrome. We provide recommendations for diagnosis and management of the disease.


Keywords


Sheehan’s syndrome, Agalactia, pituitary necrosis, postpartum hemorrhage, pregnancy

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