Why Is Sheehan’s Syndrome Frequently Misdiagnosed

Sheehan's Syndrome, a condition resulting from postpartum pituitary gland necrosis due to severe blood loss during or after childbirth, is frequently misdiagnosed for several reasons.

Firstly, the condition's rarity contributes significantly to the lack of awareness among healthcare providers. Sheehan's Syndrome is relatively uncommon in modern medical practice due to advancements in obstetric care, making it less likely for doctors to consider it a differential diagnosis, especially in countries with well-established healthcare systems1.

Consequently, many physicians may not have encountered it during training or practice, leading to potential oversight.

Secondly, the symptoms of Sheehan's Syndrome are often nonspecific and can develop gradually, complicating the diagnostic process. The syndrome primarily results in hypopituitarism, where the pituitary gland fails to produce adequate levels of hormones.

This can manifest as fatigue, weight loss, menstrual irregularities, inability to lactate, and hypotension, among other symptoms 2. These clinical features are not unique to Sheehan's Syndrome and can be attributed to a variety of other more common conditions such as postpartum depression, thyroid disorders, or adrenal insufficiency3.

This overlap in symptoms often leads to misdiagnosis or delayed diagnosis, as physicians may attribute the symptoms to more prevalent conditions.

Another critical factor is the often-delayed onset of symptoms. In some cases, the effects of hypopituitarism due to Sheehan's Syndrome may not become apparent until months or even years after the initial obstetric event4.

This temporal disconnect can make it challenging for both patients and doctors to link the symptoms back to childbirth complications. The insidious nature of symptom progression means that patients might not seek medical attention immediately. When they do, the history of severe postpartum hemorrhage might not be readily disclosed or considered relevant.

The lack of specific diagnostic markers for Sheehan's Syndrome also adds to the difficulty. Diagnosis typically relies on clinical history, physical examination, and hormone level testing, which might not always be straightforward5.

Imaging studies such as MRI can aid diagnosis by revealing an empty sella turcica, but this is not always definitive6.

The necessity of integrating various diagnostic approaches and the subtlety of clinical presentation means that a high index of suspicion is required to diagnose Sheehan's Syndrome accurately.

Without such suspicion, the condition remains underdiagnosed and mismanaged.

Footnotes
Kelestimur, F. (2003). Sheehan's syndrome. Pituitary, 6(4), 181-188. ↩

Karaca, Z., Laway, B. A., Dokmetas, H. S., & Kelestimur, F. (2014). Sheehan syndrome. Nature Reviews Disease Primers, 4, 17180. ↩

Zargar, A. H., Laway, B. A., Masoodi, S. R., Wani, A. I., Bashir, M. I., & Salahuddin, M. (2005). Clinical spectrum and diagnosis of Sheehan's syndrome. Annals of Saudi Medicine, 25(2), 106-110. ↩

Kristjansdottir, H. L., & Bodvarsdottir, S. P. (2009). Sheehan's syndrome in modern times: a nationwide retrospective study in Iceland. European Journal of Endocrinology, 160(3), 379-384. ↩

Regal, M., Páramo, C., Sierra, S. M., & García-Mayor, R. V. (2001). Prevalence and incidence of hypopituitarism in an adult Caucasian population in northwestern Spain. Clinical Endocrinology, 55(6), 735-740. ↩

Dokmetas, H. S., Kilicli, F., Korkmaz, S., Yonem, O., & Keskin, F. (2007). Evaluation of anterior pituitary function in patients with Sheehan's syndrome: report of 28 patients. Endocrine, 30(1), 65-69. ↩