Sheehan’s Syndrome – characterized by severe postpartum bleeding, shock, and hyponatremia

Sheehan’s Syndrome (SS) is a significant but often underdiagnosed cause of hypopituitarism, particularly in developing countries. This syndrome is characterized by severe postpartum bleeding, leading to lactation failure and amenorrhea. 

A new retrospective observational study analyzed 38 SS cases, focusing on age, anthropometric measurements, signs, symptoms, biochemical parameters, hormone levels, and imaging reports.

It was observed that the mean age at presentation was 36.5 years, with an average delay of 8.4 years from the last delivery to diagnosis. Lactation failure was a prominent symptom in 90% of the cases. Common findings included anemia, hypotension, hypogonadism, hypothyroidism, and altered lipid profiles. The mean blood pressure at presentation was 80.95 mmHg systolic and 51.6 mmHg diastolic. Hyponatremia and low HDL were frequent abnormalities recorded.

Of note, many patients with SS presented with amenorrhea, lactation failure, and reduced or absent axillary/pubic hair. Symptoms, such as – shock, anemia, and hyponatremia, were also prevalent. The diagnosis of SS relies on a detailed history of postpartum events in cases of hypopituitarism, regardless of the age at presentation. The authors suggest that improved antenatal care, coupled with exclusive institutional deliveries, could help reduce the prevalence of Sheehan’s Syndrome in developing countries.

Source: Agrawal P, Garg R, Agrawal M, Singh MK, Verma U, Chauhan R. The Journal of Obstetrics and Gynecology of India. 2023 Oct;73(Suppl 1):51-5.