Sheehan's syndrome: Difference between revisions
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*Evaluation of serum prolactin levels is not performed as it is difficult to differentiate low from normal serum prolactin levels | *Evaluation of serum prolactin levels is not performed as it is difficult to differentiate low from normal serum prolactin levels | ||
===Workup=== | ===Workup=== | ||
*Workup should include testing of all anterior pituitary hormones | |||
*Patients should be evaluated and treated for adrenal insufficiency immediately as this can worsen pre-existing hypotension | |||
*Other pituitary hormones can be tested for 4-6 weeks after the initial insult | |||
===Diagnosis=== | ===Diagnosis=== | ||
Revision as of 18:18, 7 October 2021
Background
- Also known as postpartum hypopituitarism
- Caused by pituitary hypoperfusion and infarction usually in the setting of postpartum hemorrhage
- During pregnancy there is enlargement of the pituitary gland predisposing it to ischemia in low-flow states
Clinical Features
- Symptoms consistent with adrenal insufficiency, hypothyroidism and hypogonadism
- Inability to lactate
- Amenorrhea or oligomenorrhea
- Fatigue
- Cold intolerance
- Lethargy
- Weight loss
Differential Diagnosis
Evaluation
- Evaluation of serum prolactin levels is not performed as it is difficult to differentiate low from normal serum prolactin levels
Workup
- Workup should include testing of all anterior pituitary hormones
- Patients should be evaluated and treated for adrenal insufficiency immediately as this can worsen pre-existing hypotension
- Other pituitary hormones can be tested for 4-6 weeks after the initial insult
Diagnosis
Management
- Currently no treatment is available but there is an ongoing small open-label pilot study looking at using recombinant human prolactin