Sheehan's Syndrome

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Classification according to ICD-10
E23.0 Hypopituitarism
- Simmonds-Sheehan Syndrome
ICD-10 online (WHO version 2019)

When Sheehan's syndrome (syn .: postpartum hypopituitarism , postpartum Hypophysennekrose) is rare, after a confinement occurring, complete ( Panhypopituitarism ) or partial failure of the maternal anterior pituitary (HVL) by cell death due to lack of blood supply ( ischemia , necrosis ).

The name refers to the British pathologist Harold Leeming Sheehan (1900–1988).

Poor blood circulation due to shock, e.g. B. also assumed by high blood loss. In rare cases, other severe shock conditions (e.g. burns) can also lead to HVL necrosis.

The diagnosis is made on the basis of the symptoms and is confirmed by endocrinological diagnostics. According to the normal hormone-producing function of the HVL, the following symptoms can develop if more than 80% of the HVL is destroyed :

  • Absence of milk penetration ( lactation , due to loss of prolactin release. Often the first symptom)
  • Missing menstruation (secondary amenorrhea , due to loss of the hormones FSH and LH)
  • Underactive thyroid ( hypothyroidism , due to loss of TSH secretion)
  • Tendency to hypoglycaemia ( hypoglycemia due to loss of growth hormone , GH, and lack of ACTH )
  • Loss of secondary body hair and
  • lack of sexual desire (loss of libido , due to ACTH deficiency and the resulting lack of steroid hormones)
  • Paleness of the skin ( hypopigmentation due to MSH deficiency)
  • In growing age: short stature (lack of growth hormone)

Occasionally, the symptoms take years to show up, making the connection to childbirth difficult to diagnose. Other causes of an anterior pituitary disorder ( tumors , injuries, autoimmune reactions) must be ruled out.

The HVL can still recover in its function even after years. Otherwise, the missing hormones or the hormones stimulated by them must be replaced for therapy, possibly for life. In particular, the lack of the thyroid-stimulating hormone TSH and the functional impairment of the adrenal cortex due to the lack of ACTH can, without treatment, cause severe disorders and even coma.

Individual evidence

  1. ^ HL Sheehan: Post-Partum Necrosis of the Anterior Pituitary. In: Transactions. Edinburgh Obstetrical Society. Volume 58, 1938, pp. 13-28, PMID 29612345 , PMC 5422597 (free full text).

literature

  • Herold, Gerd: Internal Medicine - A Lecture-Oriented Presentation , Cologne, 2005
  • Renz-Polster : Basic textbook internal medicine , 3rd edition, Elsevier, Munich 2004