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| *'''Historical Perspective'''[ Postpartum ischemic pituitary necrosis was first reported about a century ago in Przeglad Lekarski by Leon Konrad Gliński, though it was named after Harold Sheehan. Postpartum ischemic pituitary necrosis is still one of the most common causes of hypopituitarism in developing countries but it's prevalence is decreased in developed countries because of improved obstetrical care. Mostly, PPH leading to severe hypotension or shock results in Sheehan's syndrome.<ref name="pmid26817341">{{cite journal |vauthors=Krysiak R, Okopień B |title=[Sheehan's syndrome--a forgotten disease with 100 years' history] |language=Polish |journal=Prz. Lek. |volume=72 |issue=6 |pages=313–20 |year=2015 |pmid=26817341 |doi= |url=}}</ref>
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| *Pathophysiology[Apart from pituitary gland enlargement during and before parturition, vasospasm, thrombosis and compression of the hypophyseal arteries, autoimmunity, DIC and smaller size of sella are thought to play a contributing role in pathogenesis of sheehan Syndrome.<ref name="pmid15237929">{{cite journal |vauthors=Keleştimur F |title=Sheehan's syndrome |journal=Pituitary |volume=6 |issue=4 |pages=181–8 |year=2003 |pmid=15237929 |doi= |url=}}</ref>. It is thought that tissue necrosis results in release of sequestered antigens, precipitating autoimmunity of the pituitary gland and hypopituitarism in Sheehan's syndrome.<ref name="pmid12213861">{{cite journal |vauthors=Goswami R, Kochupillai N, Crock PA, Jaleel A, Gupta N |title=Pituitary autoimmunity in patients with Sheehan's syndrome |journal=J. Clin. Endocrinol. Metab. |volume=87 |issue=9 |pages=4137–41 |year=2002 |pmid=12213861 |doi=10.1210/jc.2001-020242 |url=}}</ref>. Type 1 diabetes, pre-existinfg vascular diseases and known/unknown pituitary masses are associated with increased risk of developing Sheehan syndrome in pregnancy <ref name="Abourawi2006">{{cite journal|last1=Abourawi|first1=F|title=Diabetes Mellitus and Pregnancy|journal=Libyan Journal of Medicine|volume=1|issue=1|year=2006|pages=28–41|issn=19932820|doi=10.4176/060617}}</ref>]
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| In orde
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| {{familytree/start}}
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| {{familytree | | A01 | | | A02 | | | A03 | | | A04 | | | A05 | |A01=DIC|A02=Severe PPH|A03=Glandular hypertrophy and hyperplasia|A04=Small sella size|A05=Autoimmunity}}
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| {{familytree | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | }}
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| {{familytree | | |!| | | | B01 | | | B02 | | | B03 | | | |!| |B01=Hypotension/Shock|B02=Pituitary enlargement|B03=Pituitary compression}}
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| {{familytree | | |!| | | | |!| | | | |!| | | | |!| | | | |!|}}
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| {{familytree | | |!| | | | |!| | | | C01 | | | |!| | | | |!|C01=Blood supply compression}}
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| {{familytree | | |`|-|-|-|-|^|-|-|-|-|+|-|-|-|-|^|-|-|-|-|'| }}
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| {{familytree | | | | | | | | | | | | D01 | | | D01=Ischemic Necrosis}}
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| {{familytree | | | | | | | | | | | | |!| | | | |}}
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| {{familytree | | | | | | | | | | | | E01 | | | E01=Hypopituitarism}}
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| {{familytree | | | | |,|-|-|-|-|v|-|-|^|-|-|v|-|-|-|-|.|}}
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| {{familytree | | | | F01 | | | F02 | | | | F03 | | | F04 | |F01=Amenorrhea|F02=Agalactorrhea|F03=Secondary adrenal insufficiency|F04=Hypothyroidism|}}
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| {{familytree/end}}
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| Patients of hypopituitarism may be asymptomatic or show symptoms which can be non specific or specific for the deficient hormone.[1]
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| Non specific symptoms[edit | edit source]
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| Patients of hypopituitarism may present with the following symptoms:
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| Acute hypopituitarism Chronic hypopituitarism
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| Headache
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| Nausea and vomiting
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| Visual impairment
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| fatigue
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| Cold intolerance
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| Hypotension
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| Dizziness
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| Pallor
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| Weight loss
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| Anorexia
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| Symptoms of deficient hormones[edit | edit source]
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| In hypopituitarism, either one of the pituitary gland hormones is decreased or the whole hormones are decreased in case of panhypopituitarism. In this table each hormone deficiency symptoms are listed.[2]
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| Pituitary gland Hormone Symptoms of deficiency
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| Anterior pituitary Adrenocorticotrophic Hormone (ACTH) The most critical hormonal deficient in hypopituitarism.[3][4]
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| Nausea and vomiting
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| Fatigue
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| Abdominal pain
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| Weight loss
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| Chest pain
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| Confusion
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| Growth Hormone (GH)
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| Short stature (In children)
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| Fatigue
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| Decrease muscle mass
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| Decrease bone mineral denisty which may lead to osteoporosis[5]
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| Gonadotropin hormones:
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| Luteinizing Hormone (LH)
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| Follicle Stimulating Hormone (FSH)
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| In men:
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| Loss of libido
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| Sexual dysfunction
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| Decrease bone mass
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| Decrease hair growth
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| In women:[6]
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| Amenorrhea
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| Oligomenorrhea
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| Loss of libido
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| Osteoporosis
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| Thyroid Stimulating Hormone (TSH)
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| Constipation
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| Cold intolerance
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| Weight gain
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| Dry skin
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| Prolactin
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| Inability of postpartum lactation
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| Posterior pituitary Oxytocin
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| Muscle aches
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| Sleep disturbance
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| Anxiety
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| Anti Diuretic Hormone (ADH
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| Polyuria
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| Polydypsia
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| References[edit | edit source]
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| Jump up ↑ Ascoli, Paola; Cavagnini, Francesco (2006). "Hypopituitarism". Pituitary. 9 (4): 335–342. ISSN 1386-341X. doi:10.1007/s11102-006-0416-5.
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| Jump up ↑ Fleseriu, Maria; Hashim, Ibrahim A.; Karavitaki, Niki; Melmed, Shlomo; Murad, M. Hassan; Salvatori, Roberto; Samuels, Mary H. (2016). "Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 101 (11): 3888–3921. ISSN 0021-972X. doi:10.1210/jc.2016-2118.
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| Jump up ↑ Burke, C.W. (1985). "Adrenocortical insufficiency". Clinics in Endocrinology and Metabolism. 14 (4): 947–976. ISSN 0300-595X. doi:10.1016/S0300-595X(85)80084-0.
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| Jump up ↑ Bancos I, Hahner S, Tomlinson J, Arlt W (2015). "Diagnosis and management of adrenal insufficiency.". Lancet Diabetes Endocrinol. 3 (3): 216–26. PMID 25098712. doi:10.1016/S2213-8587(14)70142-1.
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| Jump up ↑ Murray RD, Columb B, Adams JE, Shalet SM (2004). "Low bone mass is an infrequent feature of the adult growth hormone deficiency syndrome in middle-age adults and the elderly.". J Clin Endocrinol Metab. 89 (3): 1124–30. PMID 15001597. doi:10.1210/jc.2003-030685.
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| Jump up ↑ Miller KK, Biller BM, Hier J, Arena E, Klibanski A (2002). "Androgens and bone density in women with hypopituitarism.". J Clin Endocrinol Metab. 87 (6): 2770–6. PMID 12050248. doi:10.1210/jcem.87.6.8557.
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