Abstract
Hypopituitarism developing after severe post partum haemorrhage (PPH) is called Sheehan`s Syndrome. With good obstetric care Sheehan`s Syndrome became a rare entity in developed countries. In Indian context it is still an uncommon serious problem. Presentation depends on the extent of the pituitary necrosis; severe cases presenting immediately and less severe cases presenting years or decades after episode. An young woman had Pre eclampsia, ante partum haemorrhage, post partum haemorrhage at her premature twin pregnancy delivery. Three years later she presented with secondary amenorrhoea. Associated symptoms of weakness, hypotension, cold intolerance, loss of sexual hair, breast and vulval atrophy, loss of libido clinched the diagnosis. Low levels of ACTH, TSH, FSH, LH, Prolactin, and also of Estradiol, Cortisol, Sodium confirmed the diagnosis. Hormone replacement therapy with Cortisone, Thyroxine, Estrogen and Progesterone resulted in improvement of her general condition. Her menstrual cycles are established, genital organs rejuvenated and libido regained.
Key Words: Sheehans Syndrome; Post partum haemorrhage; Hypopituitarism.
References
- L. Sheehan. Post-partum necrosis of anterior pituitary. The Journal of Pathology and Bacteriology, Chichester, 1937, 45: 189-214.
- Zargar AH, Singh B, Laway BA, Masoodi SR, Wani AI, Bashir MI. Epidemiologic aspects of postpartum pituitary hypofunction (Sheehan's syndrome) Fertil Steril. 2005;84:523–8. [PubMed]
- Kristjansdottir HL, Bodvarsdottir SP, Sigurjonsdottir HA. Sheehan's syndrome in modern times: A nationwide retrospective study in Iceland. Eur J Endocrinol. 2011;164:349–54. [PubMed]
- Kale K, Nihalani N, Karnik N, Shah N. Postpartum psychosis in a case of sheehan's syndrome. Indian J Psychiatry. 1999;41:70–2. [PMC free article][PubMed]
- Huang YY, Ting MK, Hsu BR, Tsai JS. Demonstration of reserved anterior pituitary function Among Patients with amenorrhea after postpartum hemorrhage. Gynecol Endocrinol. 2000;14:99–104. [PubMed]
- Zargar AH, Masood SR, Laway BA. Pregnancy in Sheehan's syndrome: A report of three cases. J Assoc Physicians India. 1998;46:476–8. [PubMed]
- Tessnow AH, Wilson JD. The changing face of Sheehan's syndrome. Am J Med Sci. 2010;340:402–6.[PubMed]
- Bunch TJ, Dunn WF, Basu A, Gosman RI. Hyponatremia and hypoglycemia in acute Sheehan's syndrome. Gynecol Endocrinol 2002;16:419-23.
- Sert M, Tetik T, Kirim S, Kocak M. Clinical report of 28 Patients with Sheehan's syndrome. Endocr J 2003;50:297-301.
- Dökmetaş HS, Kilicli F, Korkmaz S, Yonem O. Characteristic features of 20 patients with Sheehan's syndrome. Gynecol Endocrinol 2006;22:279-83
Corresponding Author
Dr Alla Satyanarayana Reddy
Professor and HOD, Department of Obstetrics and Gynaecology,
Vinayaka Mission`s Medical College & Hospital, Karaikal, Pondicherry. 609609
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