Sheehan's Syndrome

As Sheehan's Syndrome (HVL Necrosis) denotes a lack of ACTH. It is triggered by medication or a change in the anterior pituitary gland and is now easily treatable.

What is Sheehan Syndrome?

Sheehan's syndrome always requires treatment by a doctor. Only through early detection and treatment of the symptoms can further complications be limited or completely prevented.
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Sheehan's syndrome is a functional failure of the anterior pituitary gland, which usually occurs after childbirth. The cause is high blood loss and the resulting cell death.

Other states of shock, such as burns, can also lead to HVL necrosis. The syndrome can be clearly diagnosed on the basis of various symptoms. Treatment is also possible thanks to modern medical techniques.

Often the anterior pituitary gland recovers on its own. Sheehan syndrome cannot normally be prevented. However, hemophiliacs can take appropriate precautions to avoid excessive blood loss and the associated shock.

causes

Sheehan's syndrome is caused by high blood loss with hypovolemic shock. This leads to less bleeding and a little later to ischemic necrosis of the anterior pituitary gland. The exact cause of the shock can vary widely.

The syndrome usually occurs as a result of childbirth, since blood loss is particularly high there. Injuries that result in high blood loss also lead to necrosis. These can be burns, severe cuts and similar things. However, acute illness is usually the result of childbirth.

Bleeding directly at the anterior pituitary gland can also trigger Sheehan's syndrome. It can result from a head injury and is often not even noticed by those affected. Only when headaches and hormonal problems occur can those affected intervene. Surgery is an effective way to remove the bleeding and relieve the discomfort.

Symptoms, ailments & signs

Sheehan's syndrome occurs primarily after a complicated birth of a child with high blood loss from the mother. The following symptoms appear: After the failure of the anterior pituitary lobe, there is no milk penetration (agalactorrhea), since there is no longer any prolactin release.

Further symptoms are a lack of menstruation (secondary amenorrhea) due to the loss of the hormones follicle-stimulating hormone (FSH) and luteinizing hormone (LH), an underactive thyroid (hypothyroidism), an abnormally increased urine output (polyuria) and an abnormally increased thirst (polydipsia), a tendency to low blood sugar (hypoglycaemia) due to the loss of growth hormone and a lack of adrenocorticotropin (a hormone that is also responsible for growth).

It can also lead to loss of secondary body hair, lack of sexual desire (loss of libido), paleness of the skin (hypopigmentation) due to the lack of the melanocyte-stimulating hormone and, in rare cases, short stature during growth. In Sheehan syndrome, the anterior pituitary lobe is partially or completely restricted in its function, which is why many of the necessary hormones cannot be produced.

Before diagnosis, patients are often apathetic, indifferent and limited in their living conditions. In rare cases, Sheehan's syndrome can also lead to secondary adrenal insufficiency.

Diagnosis & course

While Sheehan syndrome is a serious condition, it can be difficult to diagnose. It often takes place years later, but it can also be done after the delivery. A clear sign is a loss of secondary body hair.

A lack of sexual desire and paleness of the skin can also be symptoms. Likewise, the absence of milk penetration. Usually this is the first symptom that is triggered by the loss of prolactin release. The loss of the hormones FSH and LH, which are associated with the necrosis of the anterior pituitary gland, leads to the absence of menstruation. An underactive thyroid is also a common symptom. A tendency to hypoglycaemia can also be an indication.

The clearest sign, however, is discomfort in the eye area. If visual disturbances occur after childbirth, Sheehan's syndrome is suspected.The reason for this is the course of the optic nerve, which is located in the immediate vicinity of the pituitary gland. Eye mobility disorders are also known symptoms.

The exact diagnosis is made by a doctor. This will carry out blood tests, find out about the previous medical history and rule out other diseases as the cause. The diagnosis can then be made relatively quickly.

The course of Sheehan Syndrome can be very different. In some cases, the damaged area will recover on its own. In other cases, the deficiency can lead to serious disorders or even coma. Early treatment is therefore essential.

Complications

The complications and complaints of Sheehan's syndrome depend very much on its severity, so that a general course cannot usually be predicted. Those affected suffer primarily from a lack of milk leakage if the patient was pregnant. This can lead to growth disorders in the child, whereby the lack of milk leakage can be replaced by other products.

Menstruation is also negatively affected due to Sheehan's syndrome, so that bleeding can stop completely. Those affected continue to suffer from a significant underactive thyroid, which has a negative impact on health. Hair loss and sexual aversion occur. The sexual disorders can have a very negative effect on the relationship with the partner and possibly lead to social complaints.

In many cases, the patient's skin is very pale. If Sheehan syndrome occurs in childhood, it often leads to short stature. As a rule, Sheehan's syndrome can be treated relatively easily with the administration of hormones. There are no particular complications and in most cases the disease progresses positively. The life expectancy of those affected is also usually not negatively affected by the syndrome.

When should you go to the doctor?

Sheehan's syndrome always requires treatment by a doctor. Only through early detection and treatment of the symptoms can further complications be limited or completely prevented. The earlier Sheehan syndrome is recognized, the better the further course of this disease. A doctor should then be consulted if the person concerned suffers from a significant underactive thyroid. This usually manifests itself through various complaints and symptoms and should always be treated by a doctor. Persistent hypoglycaemia or very slow growth in children can also indicate the disease and must also be examined by a doctor.

Insufficiency or other symptoms of the kidneys are also often indicative of Sheehan's syndrome and should be examined if they occur over a long period of time and do not go away on their own. Self-healing cannot usually occur in Sheehan's syndrome. Sheehan's syndrome can be recognized by a general practitioner. Further treatment, however, depends on the exact symptoms and is then carried out by a specialist.

Treatment & course

After the diagnosis is clearly made with the help of a blood test, Sheehan's syndrome can be treated effectively. An important pillar of therapy is the supply of the missing hormones. This is done by adding various preparations.

Furthermore, complications that have already occurred must be treated, which can take a lot of time. The hormonal changes can also cause psychological problems that make treatment difficult. It is then necessary to refer the patient to a psychiatrist. Usually, however, it is sufficient to supply the missing hormones in order to restore the normal state.

Sheehan's syndrome can also be dealt with surgically. Neurosurgery can bring relief, especially if the pituitary gland is injured. The operation is performed through the nose and is very promising.

prevention

Since Sheehan syndrome usually results from sudden blood loss, it is difficult to prevent. However, it is possible to closely monitor the delivery and in particular the function of the anterior pituitary gland in order to prevent necrosis from the outset. In the event of an accident, this is of course not possible.

However, if the first symptoms are detected early, the syndrome can be diagnosed before the tissue has completely died. It is then often possible to restore the function through therapy. Finally, if you fall on your head, you should see a doctor. With magnetic resonance imaging, injuries to the pituitary gland can be detected at an early stage and then treated. This at least prevents secondary diseases.

Aftercare

In Sheehan's syndrome, the patient usually has only very limited and very few direct follow-up measures available. The person affected should therefore ideally see a doctor at the first symptoms and signs of the disease in order to prevent the occurrence of other complaints and complications. The earlier a doctor is consulted, the better the further course of the disease will usually be.

Since Sheehan syndrome is a genetic condition, it usually cannot be completely cured. Therefore, if the person concerned wishes to have children, they should have a genetic examination and advice carried out in order to prevent the syndrome from recurring in the children.

In most cases, those affected by Sheehan syndrome are dependent on the intake of various medications, which can limit the symptoms. It is always important to take it regularly and to use the correct dosage to alleviate the symptoms. Consult a doctor first if anything is unclear or if you have any questions. The disease itself does not limit the patient's life expectancy.

You can do that yourself

Special preparations are used to treat Sheehan's syndrome, which replace the missing hormones. In the context of self-help, it is also about taking into account the subsequent complications. These are often psychological complaints that are closely related to the therapy itself and that place a heavy burden on the patient.

Targeted therapy with a psychiatrist helps those affected to cope with their situation. It can drag on over a long period of time and increases the patient's self-esteem. At the same time, those affected should observe their own bodies so that they can recognize any changes early on. In this way, serious accidents or falls can be avoided.

Such situations can be avoided by taking the prescribed hormones regularly. This drug therapy can be easily integrated into everyday duties. This ensures the normal body functions and those affected can lead a normal life. Good contact with the doctor is also helpful, because patients should make an appointment at short notice in the event of already known difficulties or newly emerging problems. In this way, worse consequences can be avoided at an early stage.