Postpartum Hemorrhagic Shock-Induced Hypopituitarism Syndrome: Pathogenetic Insights

Year 1975, Volume: 28 Issue: 3-4 , 709 - 722 , 30.09.1975

Tokay Bayçın

https://izlik.org/JA53LG93HZ

Abstract

Postpartum Hemorajik Şok Hipopituitarizm Sendromu (Patojenetik Görüşler)

https://izlik.org/JA53LG93HZ

Abstract

This article presents three clinical cases of Sheehan's syndrome, a form of postpartum hypopituitarism caused by ischemic necrosis of the anterior pituitary due to severe hemorrhagic shock following childbirth. The authors analyze patient histories, physical findings, and detailed laboratory evaluations to diagnose panhypopituitarism in the absence of tumors, infections, trauma, or vascular disease.

Clinically, all three patients showed gonadal failure and hypothyroidism, with latent adrenocortical insufficiency. Symptoms included amenorrhea, loss of libido, lactation failure, hair thinning, facial edema, and general fatigue. One patient exhibited mild clinical signs of adrenal deficiency. Substitution therapy led to recovery in all three cases.

The authors argue that the syndrome is not as rare as previously thought—especially in developing regions—and may be underdiagnosed due to delayed symptom onset. They propose that pregnancy-induced pituitary hypertrophy increases susceptibility to ischemia in the context of hemorrhagic shock, setting Sheehan's syndrome apart from other causes of hypopituitarism. The article emphasizes the gradual progression of pituitary fibrosis and urges clinicians to consider this diagnosis even in cases of moderate postpartum hemorrhage.

Keywords

Sheehan , Postpartum hemorrhagic shock , Hypopituitarism , Adenohypophysis necrosis , Pituitary insufficiency , Gonadal failure , Hypothyroidism , Adrenocortical insufficiency , Pluriglandular deficiency , Endocrine pathology

References

• 1. Bayçın T, Özdemir Aİ. Sheehan Sendromu. Deniz Tıp Bülteni. 1964;10:38.
• 2. Bayçın T, Özdemir Aİ. Sheehan Sendromu. AÜTF Mec. 1965;XVIII(4).
• 3. Cecil-Loeb. Textbook of Medicine. 3rd ed. W.B. Saunders; 1971. p.1737–1738.
• 4. Faria JI, Oliveira NR. Hypophysennekrose nach Schockzuständen. Beitrag Path. Anat. 1962;127:213–231.
• 5. Israel SI, Constan AS. Unrecognized Pituitary Necrosis. JAMA. 1952;148:189–193.
• 6. Kahn J. L'insuffisance hypophysaire du postpartum. La Sem. des Hop. 1955;22:1286.
• 7. Koloğlu S. Endokrinoloji. 1. Baskı. Ankara: Balkanoğlu Matbaacılık; 1961. p.61.
• 8. McKay DG. Pituitary. In: Disseminated Intravascular Coagulation. New York: Hoeber Medical Division; 1965. p.405–460.
• 9. Qerido A, van der Werfften Bosch JJ, Blom PS, van Gilse HH. Postpartum Hypopituitarism: Report of 14 Cases. Acta Med Scand. 1954;149:291–310.
• 10. Sheehan HL. The Incidence of Postpartum Hypopituitarism. Am J Obstet Gynecol. 1954;68:202–224.
• 11. Sheehan HL, Davis JC. Pituitary necrosis. Br Med Bull. 1968;24:59.
• 12. Sheehan HL, Summers VK. The Syndrome of Hypopituitarism. Q J Med. 1946;42:319.
• 13. Schneeberg NG, Perloff WH, Israel SL. Incidence of Unsuspected Sheehan's Syndrome. JAMA. 1960;172:70–78.
• 14. Sodeman WA. Pathologic Physiology. 3rd ed. W.B. Saunders; 1961. p.149.
• 15. Titiz İ, Oktay S, Aktan H. İç Hastalıkları: Semptomatoloji ve Tedavi. 2. Baskı. Türk Tarih Kurumu; 1975. p.1217.
• 16. Williams RH. Textbook of Endocrinology. 3rd ed. W.B. Saunders; 1962. p.45.