Sheehan’s Syndrome Overview

Sheehan's Syndrome Overview

What Is Sheehan’s Syndrome?

Sheehan’s Syndrome is a disease that affects the function of the pituitary gland.

What Causes Sheehan’s Syndrome?

Sheehan’s Syndrome may happen if a woman loses a severe amount of blood during or after childbirth.

Hormone producing tissue of the pituitary gland may become destroyed from the loss of blood at childbirth.

If necrosis (death) of the pituitary gland occurs, the pituitary gland may lose some or all of its function.

The damage to the pituitary gland can affect the pituitary gland’s ability to signal other glands.

The pituitary gland signals other glands to increase or decrease the production of hormones that control:

  • stress
  • muscle mass
  • urinary output
  • metabolism
  • fertility
  • wound healing
  •  many other vital processes

How To Understand Sheehan’s Syndrome

A simple way to understand Sheehan’s Syndrome is to picture the female body like a car.

The pituitary gland is the automobile’s ignition switch.

The car (female) has all working parts, except a nonfunctioning ignition switch (pituitary gland).

The car is not able to start if the ignition switch (pituitary gland) does not function.

You can have a beautiful looking car, a full tank of gas and brand new tire but without an ignition, you are going nowhere.

The same is true about the pituitary gland. If your pituitary gland does not send out signals to other glands to function, then your body does not work.

Hormones Released By The Pituitary Gland

The pituitary gland is responsible for sending out some of the following hormones:

  • Growth hormone (GH)
  • Puberty hormones (or gonadotrophins)
  • Thyroid-stimulating hormone (TSH, stimulates the thyroid gland to make Thyroxine)
  • Prolactin
  • Adrenocorticotrophic Hormone (ACTH, controls cortisol release)
  • anti-diuretic hormone (ADH)

Each Pituitary Gland Hormone plays a sufficient role in the body’s function .

Pituitary Gland Hormone Breakdown

  • Growth hormone (GH):

Growth Hormone is essential in early years for growth in children and to maintain a healthy body composition. In adults, Growth Hormone helps to promote healthy bone, muscle mass and affects the distribution of fat.

  • Puberty hormones (LH, FSH):

Luteinizing hormone (LH): LH works with FSH to ensure normal functioning of the ovaries and testes.
Prolactin: Prolactin stimulates breast milk production.

  • Thyroid-stimulating hormone (TSH):

TSH stimulates the thyroid gland to produce hormones.

  • Prolactin:

Prolactin stimulates breast milk production

  • Adrenocorticotropic hormone (ACTH):

ACTH stimulates the production of cortisol by the adrenal glands.

The adrenal glands are kidney sized glands that rest on top of the kidneys.

Cortisol, is vital to our survival. Cortisol allows the body to maintain blood pressure, blood glucose levels, and our body releases higher amounts of cortisol when the body is under stress of injury or sickness.

  • Anti-diuretic hormone (ADH):

The ADH hormone signals the kidneys to increase water absorption in the blood.

Sheehan’s Syndrome, Hypopituitary Medication

If your pituitary gland becomes damaged from Sheehan’s Syndrome, then you may lose the function of your pituitary gland all at once or over time.

The balance of medications consumes a significant portion of my daily life.

While I am fortunate that there are pituitary medications available, it ‘s hard for me to balance my medication needs correctly.

My pituitary gland replacement drugs try to mimic what my body would produce naturally, but it is a continuous struggle.

Here is the list of Pituitary Gland medications I take daily:

  • Prednisone (A form of steroid)
  • Florinef (A form of steroids that primarily replaces aldosterone)
  • Levoxyl (A type of thyroid medication that converts T4 thyroid into T3)
  • Armour (A kind of thyroid medication that delivers T3)
  • Humatrope (Growth Hormone)
  • Testosterone (Bio-gel replacement)
  • Estrace (Typical- Due to my pulmonary embolism experience I am not able to use oral estrogen medication)
  • DHEA (DHEA (dehydroepiandrosterone) is a hormone produced by your body’s adrenal glands.)

If you have an ACTH deficiency, then you must take steroids daily.

You may also need to take medication if you have additional pituitary gland insufficiency.

There are numerous forms of steroid medications.

You need to find the steroids and the steroid dosage that works best for your endocrine system.

Below you can find a Steroid Conversion Chart

best steroid conversion chart

Steroid Conversion Chart

Where Is The Pituitary Gland Located?

The pituitary gland is located in the middle of the skull, underneath the brain and behind the bridge of your nose.

A saddle-shaped box called the Sella Turcica encases the pituitary gland.

The pituitary gland is a protrusion off the bottom of the Hypothalamus.

The pituitary gland is about the size of a large pea and weighs approximately .5 grams.

The pituitary gland sits in a tight space, and any abnormal growth, compression or head drama can result in damage to the pituitary gland’s signal process.

What Are The Parts Of The Pituitary Gland?

The Pituitary Gland consist of three lobes: the Anterior, Immediate and Posterior

  • The Anterior Lobe is inside the pituitary gland
  • The Intermediate Lobe is located between the Anterior Lobe and Posterior Lobe
  • The Posterior Lobe is the outside portion of the Pituitary Gland

The posterior lobe portion of the pituitary gland connects to the Hypothalamus through a small tube called the Pituitary Stalk.

Sheehan’s Syndrome Symptoms

The symptoms of Sheehan’s Syndrome can be difficult to pinpoint.

You may feel like you are going crazy before you have a diagnosis of Sheehan’s Syndrome.

Unfortunately, the symptoms of Sheehan’s Syndrome frequently are misinterpreted and given incorrect labels.

The extreme fatigue associated with Sheehan’s Syndrome is often categorized with motherhood or being a new mother.

Sheehan’s Syndrome symptoms may be different for each Sheehan’s Syndrome Women.

The symptoms of Sheehan’s Syndrome usually appear over a period of months or even years. However, the signs of Sheehan’s Syndrome may result immediately in some women.

It is hormone deficiency from the pituitary gland (master gland) that causes Sheehan Syndrome symptoms to occur.

Here are several symptoms of Sheehan’s Syndrome:

  • Difficulty breastfeeding ( lack of breast milk)
  • Irregular heartbeat (May feel like a racy heartbeat at times.)
  • No menstrual periods (amenorrhea) or infrequent menstruation (oligomenorrhea)
  • The loss of pubic or underarm hair
  • Slow mental function (forgetfulness and brain fog)
  • Weight gain even when dieting
  • Difficulty staying warm (this is a result of an underactive thyroid)
  • Low blood pressure (May feel light headed and dizzy)
  • Fatigue (So exhausted you can barely move out of bed)
  • Loss of interest in sexual activity

For some women with Sheehan Syndrome, the symptoms are nonspecific and are explained as the result of new motherhood duties. The overwhelming fatigue, for example, goes hand in hand with being a new mother.

A woman may not realize she has Sheehan’s Syndrome until there is a need for thyroid treatment or adrenal insufficiency.

If there is not immediate damage to the pituitary gland (Master Gland), it is possible for some Sheehan Syndrome women to remain relatively symptom-free of symptoms until she experiences an extreme physical stressor.

The physical stressor that triggers the Sheehan’s Syndrome symptoms may be a severe infection or surgery.

If a Sheehan’s Syndrome woman goes into extreme stress, the result may be an acute adrenal crisis.

An adrenal crisis is an Acute adrenal crisis.

An adrenal crisis is a life-threatening condition that occurs when there is not enough cortisol.

The adrenal glands produce the hormone cortisol.

The pituitary gland sends messages to your adrenals to release cortisol. If your pituitary gland is damaged, it may not be able to sign the adrenal glands.

How Do You Test For Sheehan’s Syndrome?

Lab tests for Sheehan’s Syndrome (Hypopituitarism) can be incredibly frustrating and expensive.

If you suspect that you have Endocrine issues then complete lab work would be extremely beneficial.

I have found that many doctors will not run anything more than standard medical labs, ie. CBC panel.

Here are some of the additional lab test you may want to request if you feel you have Sheehan’s Syndrome Symptoms:

  • Cortisol Levels (drawn first thing in the morning)
  • ACTH (drawn first thing in the morning)
  • TSH ( thyroid)
  • Free T4 (thyroid)
  • Free T3 (thyroid)
  • LH
  • FSH
  • Progesterone
  • Estradiol
  • Testosterone
  • Hemoglobin A1C
  • IGF-1 (insulin growth factor/growth hormone)

Almost all Endocrinologists and medical information state that the IGF-1 (growth hormone) is the first pituitary gland hormone to fail in Sheehan’s Syndrome.

I find medicine can be subjective and extremely expensive.

Even with extensive lab work you can have normal lab results, be very ill and still have Sheehan’s Syndrome.

To make a definite diagnosis of Sheehan’s Syndrome an ACTH Stimulation Test should be given to test cortisol output, an Arginine Stimulation Test should be given to test for IGF-1, and an MRI of the pituitary should be done to see if the pituitary has an Empty Sella.

Some people prefer to have their ACTH and IGF-1 tested with an ITT Stimulation Test. However, this test has more risk involved.

On a personal note, I was always within range on all my CBC lab tests for Sheehan’s Syndrome.

My IGF-1 was always within lab results normal range, and my growth hormone was one of my last hormones to die out.

I did fail both the stimulation test for ACTH and Growth Hormone.

Lab Results For Sheehan’s Syndrome

Helpful Tips

  • Please be sure to ask for all copies of your labs
  • You are entitled to a copy of your lab tests
  • You need to keep copies of all of your medical records

If you are trying to interpret lab results then lab test online is an awesome resource tool.

I hope you have found Sheehan’s Syndrome Overview helpful.

 

Resources:

http://www.mayoclinic.org/diseases-conditions/sheehans-syndrome/basics/symptoms/CON-20029870

https://medlineplus.gov/ency/article/000357.htm

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183525/

 

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