Sheehan’s syndrome: What is postpartum hypopituitarism?

Sheehan’s syndrome is a rare medical condition caused by damage to the pituitary gland during childbirth . This damage may cause hypopituitarism (hormone deficiencies) and affect how well the pituitary gland can produce and store hormones.

This article will detail what exactly causes Sheehan’s syndrome, the treatments for the condition and how you might seek compensation for birth injuries.
 

What is Sheehan’s syndrome?

Sheehan’s syndrome can occur when the pituitary gland at the base of the brain has been damaged. The pituitary gland is considered the ‘master gland’ because it controls several other hormone glands within the body.

Hormones stored and produced in the pituitary gland help to control various functions in the body including growth, breastfeeding, thyroid function, metabolism (the way the body uses energy), and the functions of sex organs. Sheehan’s syndrome may affect these hormone levels as they can no longer be stored and used by the body.

Sheehan’s syndrome causes

Sheehan’s syndrome may be caused when a woman loses a large amount of blood or has severely low blood pressure and consequent shock , during or after childbirth. It occurs when 75 to 90 per cent of the anterior pituitary gland has been damaged.

This loss of blood during childbirth can starve the body of oxygen, which can cause damage to the pituitary gland. As a result, organ damage may occur if the pituitary gland is no longer able to store or produce vital hormones.

What are the main Sheehan’s syndrome symptoms?

The symptoms of this syndrome may include:

• Difficulty or inability to breastfeed
• Irregular or no periods
• Decreased libido
• Low blood sugar and pressure
• Weight gain
• Intolerance to cold

If your thyroid is underactive as a result of this condition, you may experience:

• Fatigue
• Weight gain
• Constipation
• Dry skin
• Sluggishness

 

Getting a Sheehan’s syndrome diagnosis

 
In order to create a diagnosis of Sheehan’s syndrome, the doctor will consult your medical history, to see if you experienced any complications in childbirth. They may also ask if you have had any difficulty breastfeeding or a lack of menstruation, as these are two main symptoms of Sheehan’s syndrome.

You may then undergo blood tests to check the function of your pituitary glands, and be referred to an endocrinologist if the range looks unusual. Then, a computerised tomography (CT) or magnetic resonance imaging (MRI) scan might check the size of your pituitary gland .

These scans can also check for other concerns that could be causing similar symptoms1.

What are the treatments for Sheehan’s syndrome?

While the exact treatment method varies based on the individual condition, typically the treatment involves replacing the hormones your body can no longer produce. These may include oestrogen, or oestrogen with progesterone, to help with your menstruation. Or levothyroxine to increase the levels of hormones from your thyroid.

With well-managed hormone therapy, it is very possible to live a healthy life with Sheehan’s syndrome.
 

Living with Sheehan’s syndrome: Ellen’s story

 

A difficult labour

Ellen* gave birth to her first son in hospital. She lost nearly half a litre of blood during labour. After the birth she had a second-degree tear stitched, but the bleeding did not stop. She started to feel unwell and told the midwives, but they couldn’t explain what was happening and it did not seem much of a concern.

A few hours later, Ellen started to feel cold, clammy, and faint. Midwives found her blood pressure had become very low.

Eventually, Ellen was examined by a doctor who found a large haematoma (a collection of blood) in the wall of her vagina. Ellen had been bleeding heavily for over four hours by this time.

As a lot of the blood had been collecting internally, the midwives had underestimated the amount of blood she had lost. Ellen had to have emergency surgery to have the blood removed. The doctors estimated she had lost about 1.3 litres of blood (more than two pints) in total.

Symptoms after birth

In the months after she gave birth, Ellen was exhausted and constantly cold. She had lost her appetite and her joints ached all over. She lost a stone from her pre-pregnancy weight and her hair started to fall out. She tried to breastfeed her new-born son, but she wasn’t producing enough milk.

After a few months, Ellen went to her GP and was referred to an endocrinologist – a doctor specialising in the glands in the body which produce hormones. Tests showed that Ellen was suffering from the rare endocrine disorder Sheehan’s Syndrome, due to the amount of blood she had lost after the birth of her son.

Ellen’s body now couldn’t produce the hormones that control metabolism (the way the body uses energy), respond to illness or stress, control growth, produce breast milk or cause periods.

Treatment and support

Ellen’s condition could be treated with drugs to artificially replace the hormones her body couldn’t produce any more, but it wasn’t a perfect replacement, and she would often suffer periods of fatigue. This meant Ellen wasn’t able to go back to work full-time and needed extra help around the house and looking after her son.

She also had to be very careful with her dosage of medicine if she became ill or stressed, as her body wasn’t able to respond by itself. Her life could be at risk if she didn’t make sure her body received enough of the artificial hormones.

Exploring a medical negligence claim

Enable Law acted for Ellen in her claim. We showed that the midwives treating Ellen during her labour should have raised the alarm much earlier. If this had happened, Ellen’s internal bleeding would have been found much sooner, she wouldn’t have lost as much blood, and she would not have developed Sheehan’s syndrome.

*Names have been changed
 

Your Sheehan’s syndrome journey

 
If you’re diagnosed with Sheehan’s syndrome, your future might look uncertain. Although your needs may now be different, the right support can help you to lead a happy life.

If you’ve been given a diagnosis of Sheehan’s syndrome and you think your labour might not have been managed properly, get in touch with our specialist maternity negligence team for advice.
 

Sheehan’s syndrome: Key questions

 

Is Sheehan’s syndrome reversible?

Sheehan’s syndrome is unfortunately not reversible. The pituitary gland is unable to regenerate, meaning that the damage is irreversible . But, with hormone therapy, the symptoms may be minimised, allowing you to live a normal life.

Can Sheehan’s syndrome cause headaches?

Although headaches aren’t typically recognised as a symptom of Sheehan’s syndrome, some experience mild headaches . However, there may be other causes of headaches in women with Sheehan’s syndrome.

Can you get pregnant with Sheehan’s syndrome?

It can be difficult to get pregnant with Sheehan’s syndrome but it may be possible with assistive reproductive technology. Pregnancies come with increased risk of complications, including post-partum haemorrhage, however. Hormone levels must be resolved to a normal level before pregnancy and increased medical attention throughout the pregnancy will be necessary. If you were thinking of starting or expanding a family, you may be able to claim these costs as part of your claim – we will be able to advise you more on this if you contact us.