Are you aware of Sheehan Syndrome, which can occur after childbirth?

Do you remember how we used to talk about how sometimes mothers experience strange symptoms after giving birth? Maybe they don't produce enough milk for their baby, their periods suddenly stop, or they feel extremely tired all day long. These are not just random things, they can sometimes be the result of complications during childbirth. Today we're going to talk about a rare but very important childbirth-related condition that everyone should be aware of.

What is Sheehan Syndrome?

Simply put, Sheehan Syndrome is a rare condition that affects your pituitary gland . It occurs when there is excessive bleeding during childbirth, meaning a large amount of blood is lost from the body. Think about it, your pituitary gland is a small but very important gland at the base of the brain. We call it the "master gland" because it produces hormones that control many important processes in the body, and it also tells other glands to produce hormones. So, when there is excessive bleeding during childbirth, this pituitary gland does not get the amount of oxygen it needs. Just like a tree dies without water, when it goes without oxygen, some of the tissues in the pituitary gland die. This pituitary gland gets a little bigger during pregnancy, so it is more likely to be damaged. When the pituitary gland is damaged in this way, it can affect various systems in the body, such as the brain, reproductive system, muscles, skin, energy, and even the psyche. This Sheehan Syndrome is also called `postpartum hypopituitarism` or `postpartum pituitary necrosis`.

What happens to the body with Sheehan syndrome?

When the pituitary gland is damaged, it loses its ability to produce several important hormones that the body needs. Here's what they are:

• Adrenocorticotrophic hormone (ACTH): This stimulates the production of cortisol, the body's main stress hormone. Cortisol is a hormone that regulates blood pressure, blood sugar levels, and helps the body cope with stress.
• Thyroid-stimulating hormone (TSH): This stimulates the thyroid gland . The thyroid regulates metabolism, energy, and the nervous system.
• Growth hormone (GH): Helps maintain bone density, muscle mass, and fat distribution.
• Follicle-stimulating hormone (FSH): Stimulates the production of estrogen in the ovaries, and causes an egg to mature each month.
• Luteinizing hormone (LH):It helps with ovulation, which is the release of an egg from the ovaries.
• Prolactin (PRL): Stimulates milk production during pregnancy and enables the baby to breastfeed.

So you can probably understand that if any of these hormones is lacking, the relevant function in the body will not work properly.

How common is this situation?

With modern medical treatments, Sheehan Syndrome is a very rare condition . It occurs in approximately 5 out of every 100,000 births. However, it may be more common in areas where emergency medical care is lacking to prevent excessive bleeding during childbirth.

What are the symptoms of this?

Symptoms of Sheehan syndrome can sometimes be seen immediately , that is, soon after the baby is born. However, sometimes these symptoms can appear gradually, over months or even years . The main symptoms that can be seen are:

• Difficulty breastfeeding or no milk coming in after the baby is born.
• Complete cessation of monthly menstruation ( amenorrhea ) or irregularity.
• The walls of the vagina become thin and dry ( vaginal atrophy ), which can make sexual intercourse painful.
• Breast shrinkage and hair loss in the armpits and private areas.
• Extreme fatigue , low energy, and difficulty concentrating.
• Decreased sexual desire.
• Low blood pressure.
• Dry skin.

Importantly, sometimes you may have no major symptoms and then suddenly experience a major stressor in your life – for example, surgery, a major infection, or an accident – ​​and your body may not have enough cortisol to cope with it, leading to symptoms. This is called an adrenal crisis . This is a life-threatening condition that requires immediate medical attention.

Why does Sheehan syndrome occur?

The main reason for this is excessive bleeding during childbirth . As I mentioned earlier, the pituitary gland enlarges during pregnancy, sometimes doubling in size. This makes it more susceptible to oxygen deprivation, especially if there is a lot of bleeding or a sudden drop in blood pressure. When there is a lack of oxygen, the cells in the pituitary gland are damaged. As a result, the pituitary gland is unable to produce enough hormones to control various functions in the body. These hormone deficiencies can cause the reproductive system and nervous system to function poorly or even stop altogether.

Is this something that comes from generations?

No. Sheehan syndrome is not a condition that you inherit from your parents.

How much blood loss is needed to put this condition at risk?

Typically, the risk of developing Sheehan's syndrome is only increased if you have a life-threatening blood loss, a severe drop in blood pressure, and shock. However, because your medical team is prepared for these emergencies, this risk is now much lower.

What are the risk factors?

We now know that Sheehan syndrome only occurs when there is excessive bleeding during childbirth and the blood pressure drops too low. So, conditions that increase the risk of excessive bleeding during childbirth also increase the risk of Sheehan syndrome. Such conditions include:

• Giving birth to more than one child (such as twins, triplets).
• Giving birth to a baby that is larger than normal.
• Placental abruption .
• Placenta previa (low placenta ).
• High blood pressure during pregnancy ( preeclampsia ).
• Instrumental delivery (e.g. forceps or vacuum extraction ).

What are the complications of Sheehan syndrome?

If Sheehan syndrome causes an adrenal crisis later in life, it can be life-threatening. In addition, other complications of this condition can include:

• Low blood pressure.
• Loss of body weight or muscle mass.
• Irregular menstruation or difficulty getting pregnant again.

But don't worry, your doctor can help you manage or prevent these complications with proper treatment.

How do you recognize this?

If you have symptoms of Sheehan's syndrome, your doctor may use the following to diagnose the condition:

• Medical history: Your doctor will ask about any previous heavy bleeding or other complications you have had during your pregnancy. You will also need to talk about any symptoms you have had after giving birth (for example, difficulty breastfeeding, or a missed period). Be clear about your current symptoms, how long they have been present, and what you do to make them better or worse.
• Blood tests: A sample of your blood is taken and the levels of hormones related to the function of the pituitary gland are checked.
• Imaging tests: An MRI (Magnetic Resonance Imaging) scan can rule out other causes of your symptoms (for example, a pituitary tumor). If the MRI results are unclear, a CT scan (Computed Tomography scan) may also be done.

What are the blood tests used to diagnose?

The doctor may test your hormone levels directly, or they may also look at how your pituitary gland responds to a certain stimulus.

• Hormone Level Testing: Hormone levels such as ACTH, FSH, LH, TSH, T4, estradiol (a type of estrogen), IGF-1, and cortisol can be checked.
• Stimulation tests: Your doctor may give you a medication or injection to stimulate certain hormones produced by the pituitary gland and assess how the pituitary gland responds to it.

How is it treated?

To treat this condition, you will need to take hormones for the rest of your life . This means that your body will give you hormones that it no longer produces. This is also called hormone replacement therapy . The types of hormones you need, how much, and how you take them will vary depending on your diagnosis and symptoms. These hormones may include:

• Sex hormones: Estrogen and progesterone can be taken to regulate your monthly period and help with symptoms of premature menopause. Hormones like LH and FSH help with ovulation, which can also help you get pregnant again.
• Corticosteroids: You can take hydrocortisone or prednisone to treat ACTH deficiency. Your dose of these hormones may need to be adjusted if you are under a lot of stress (such as surgery) because your body needs to produce more cortisol.
• Thyroid hormones: Levothyroxine (e.g., Synthroid®, Levoxyl®) can be used for TSH deficiency. The dosage of this medication will be adjusted based on your thyroid hormone levels.
• Growth hormones: Taking growth hormones can help maintain muscle mass and bone density.

In most cases, you will be treated by an endocrinologist , a doctor who specializes in hormones. He or she will also perform regular tests to make sure your hormone levels are within a healthy range.

Can Sheehan's syndrome be prevented?

No, there is nothing you can do to prevent Sheehan Syndrome. Your medical team can only control bleeding and blood pressure during labor and delivery. But keep in mind, Sheehan Syndrome is a very rare condition . Having a skilled medical team who can prevent complications like excessive bleeding during labor and delivery greatly reduces your risk of developing this condition.

What happens if I have Sheehan syndrome?

With proper treatment, a person with Sheehan syndrome can expect a very good recovery.Most people do not develop serious complications. With close monitoring by the medical team, some people have been able to successfully conceive after diagnosis. You should see your endocrinologist regularly to make sure you are receiving the right medications to correct any hormonal imbalances. Regular blood tests to check your hormone levels are also part of this follow-up care.

What is the life expectancy of someone with hypopituitarism?

If you have Sheehan syndrome, your life expectancy will not change. Although you will need lifelong treatment, you can expect a normal life expectancy.

When should I see a doctor?

If you have symptoms of Sheehan syndrome, especially if you have had heavy bleeding during childbirth , see a doctor immediately. Your doctor can perform tests to determine if you have this condition.

When should I go to the emergency room?

If you have symptoms of an adrenal crisis , you should go to the emergency room immediately. This can be life-threatening if left untreated. These symptoms include:

• Feeling dizzy, like you're about to lose consciousness.
• Severe pain in the stomach, lower chest, or back.
• Fever.
• Lifeless body.
• Nausea and vomiting.
• Confusion or loss of consciousness.

If your doctor thinks you are at risk, they may ask you to wear a medical alert bracelet to get quick treatment in the event of an emergency.

What questions should I ask the doctor?

You can ask your doctor questions like:

• How does Sheehan syndrome affect my body?
• How will treatment improve my symptoms?
• Can you get pregnant with Sheehan syndrome?
• How often will I need to have blood tests?
• What medications or treatments do you recommend?

Damage to the pituitary gland can affect many body processes that depend on healthy hormone levels. Hormone replacement therapy can help to address some of the effects of hormone deficiency. Talk to your doctor about how Sheehan syndrome will affect your lifestyle and overall well-being. Also, discuss how often your doctor will check your hormone levels to make sure you are getting the right medications for your health.

Finally, things to remember

Sheehan Syndrome is a rare condition caused by damage to the pituitary gland due to excessive bleeding during childbirth. This can lead to various hormone deficiencies, and symptoms such as difficulty breastfeeding, cessation of menstruation, and extreme fatigue.

The best thing is that this condition can be successfully managed with lifelong hormone therapy and a normal lifespan can be achieved.

If you have these symptoms, especially if you have had complications during childbirth, it is very important to seek medical advice. If detected early, you can start treatment and stay healthy.

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` Sheehan's syndrome, pituitary gland, childbirth, bleeding, hormones, women's health, postpartum care