EpistemisSheehan syndrome
Specialty: Gynecology and breast.
Why it occurs
- Ischemic necrosis of the pituitary gland (which is physiologically enlarged and hypervascularized during pregnancy) secondary to an episode of severe hypovolemic shock or profound hypotension due to massive intrapartum or postpartum hemorrhage
Initial workup
Basal analytical determination of pituitary and peripheral hormones: Prolactin, FSH, LH, Estradiol, TSH, free T4, ACTH, basal Cortisol at 8 AM, GH and IGF-1. ACTH stimulation test or insulin tolerance test if the results are borderline. Magnetic Resonance of the sella turcica (initially shows pituitary enlargement and inflammation, later evolving to the image of "empty sella turcica" with complete glandular atrophy).
red flags
Absolute inability to breastfeed due to the complete absence of breast milk production after childbirth (agalactia due to prolactin deficiency), asthenia and extreme lethargy, persistent severe hypotension that does not respond to fluids, loss of axillary and pubic hair that does not grow back, severe recurrent hypoglycemia or signs of acute adrenal crisis (nausea, vomiting, extreme hypotension, shock).
Standard management
- Hydrocortisone 15-20 mg/day orally divided into two or three doses (or Prednisone 5 mg/day in the morning) to treat ACTH deficiency, always started before replacing thyroid hormone to avoid triggering an acute adrenal crisis
- Levothyroxine sodium 50-100 micrograms/day orally for secondary hypothyroidism
- Hormone replacement therapy (estrogen and progesterone) to restore menstrual cycles and protect bone density in premenopausal women (note: requires close, lifelong follow-up by endocrinology).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 1
- Treatment options
- 3