Sheehan Syndrome - Postpartum hypopituitarism

Optimal obstetric care postpartum pituitary necrosis transformed into an unusual condition in developed countries, however, remains a common cause of hypopituitarism in less developed countries.
Important causes of pituitary necrosis include severe bleeding during and before parturition. Addition of blood to the already increased pituitary volume is severely compromised during acute volume depletion caused by vasospasm. Oversized gland and low-pressure portal system to determine succeptibilitatea tissue hypoperfusion and stroke.
An atrophic gland, hipofunctionala, healing is the result of Sheehan's syndrome. It has been suggested that patients with this syndrome have been rigid, than at first. Gland hyperplasia in such is less likely to themselves to compress the intake of blood and predispose the gland to heart if hypotension occurs. Pregnant women with type I diabetes, especially those with preexisting vascular disease appear to be particularly at risk.
The most common form of presentation of Sheehan's syndrome is the complete absence of lactation and breast involution. These are followed by nereluarea menses hair growth and shaving of pubic and armpit. Progressive symptoms of hypothyroidism and hipoadrenalism appear. These nonspecific cause fatigue, muscle pains and malaise. Hypotension and acute adrenal crises are unusual only under stress. Skin pigmentation is increased. Mental disorders are common and sometimes the patient may present frank psychosis. These changes are reversible with additional hormones.Women with type I diabetes may reduce insulin requirements.
Treatment includes hormone replacement with physiological doses of glucocorticoids and sex steroids to increase the levothyroxine dose glucocorticoids for proper stress.Sex steroids are administered by different routes and formulations. Ovulation induction with exogenous gonadotropins or pulsatile GnRH may be necessary for the tasks you want. Some women with low libido may require androgen replacement.
Pathogenesis and causes:
Most of the deficiencies of prolactin, deficiency of anterior pituitary dysfunction is secondary general. The condition is most often associated with postpartum pituitary necrosis, however, prolactin deficiency can be caused by the development of tumors of the salivary gland or tumor treatment, parasellare diseases, head injuries, infection or infiltrative diseases.Partial prolactin deficiency is rare and has a genetic component. Although metabolic and endocrine function of prolactin is not yet fully understood, the clinical manifestations of deficiency are likely to be limited to alactogeneza puerperium.
Sheehan's syndrome is characterized by the inability of the gland to secrete prolactin and puerperal lactogenezei absence. Other pathological mechanisms have not yet been fully established. Prolactin is mainly regulated by tonic inhibition than intermittent stimulation. Determine dopamine prolactin secretion.Menstrual disorders, delayed puberty, were associated with hypoprolactinaemia subfertilitatea mechanisms are not yet known.
Signs and symptoms:
Symptoms depend on the degree of necrosis of the pituitary gland.
Asymptomatic form:In light Sheehan sidnromul symptoms may not occur at all. The woman may complain of general malaise and fatigue, a phenomenon that passes the side effects of birth, anemia and poor nutrition.
The first symptoms after childbirth:The moderate degree of syndrome the first signs usually appear within the first few months after birth. The woman can not breastfeed even if they make the greatest efforts.Breasts and genitals shows signs of atrophy.
Late symptoms of Sheehan's syndrome complete:In Sheehan's syndrome is due to complete suppression of the main symptoms developed thyroid and adrenal gland (Cushing's and Addison's disease).She has a typical pale face, fluffy, dry hair, areflexia, Iin weight increase, hypotension, slow mental functioning. Sometimes you can see the manifestations of psychological pathology. Atrophied breasts and genitalia are absent pubic and axillary hair. Tolerance can be reduced insulin and type I diabetes may occur
Diagnosis:
Laboratory evaluation showed partial hypopituitarism or panhipopituitarism with low thyroxine, estradiol and cortisol low, inadequate levels of TSH, FSH, LH and ACTH.Cortisol response to ACTH is weak.Imaging Studies:Even if there is a clear association with parturition MRI or CT scan imaging is indicated to rule out mass lesions. In Sheehan's syndrome is often long saddle empty, filled only by the CSF. Occasionally small remnants of pituitary tissue can be observed.
Treatment:
In general formula feeding is recommended for infants and puerperal women hypoprolactinaemia insufficient milk. Medicines to increase intake of breast milk are not effective.There are no medicines to treat prolactin deficiency, however, recombinant human prolactin has been made experimentally proved to be effective in correcting the lactation performance of mice treated with bromocriptine.
Inadequate breastfeeding may respond favorably to antidopaminergici agents that block dopamine-induced hypothalamic control. Metoclopramide has been shown to increase significantly in the placebo milk production in patients with inadequate lactation.Subfertilitatea caused by hypoprolactinaemia can be treated with clomiphene citrate or gonadotropin.