Sheehan's syndrome physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Overview

Patients with Sheehan's syndrome usually appear fatigued, lethargic, and complain of recent weight gain. Physical examination is usually remarkable for bradycardia, hypotension, pallor, and signs suggestive of respective hormonal deficiency. Clinical features depend upon the severity of hypopituitarism.

Physical Examination

Clinical features depend upon the severity of hypopituitarism that results from Sheehan's syndrome. Almost all the patients have growth hormone (GH), prolactin, and gonadotropin deficiency; the majority has adrenocoticotropic hormone (ACTH) and thyroid stimulating hormone (TSH) deficiency.

Hypopituitarism	Presentation
Mild	Remains undiagnosed for many years
Less severe	Postpartum agalactorrhea and amenorrhea (week/months after delivery) Loss of sexual hair Mild degree of: fatigue Anorexia Weight loss
Severe	Lethargy Anorexia Weight loss Postpartum agalactorrhea (days/week after delivery)

Examination findings based upon specific hormonal deficiency

Hormonal deficiency	Finding
ACTH	Acute	Postural hypotension Tachycardia
	Chronic	Anorexia Weight loss No hyperpigmentation
TSH	Slow movement and slow speech Delayed relaxation of tendon reflexes Bradycardia Carotenemia Coarse skin Puffy faces and loss of eyebrows Periorbital edema Enlargement of the tongue Diastolic hypertension Pleural and pericardial effusions Ascites Galactorrhea
Gonadotropins	Breast atrophy Regression of sexual characteristics
Growth hormone	Decreased sweating and impaired thermogenesis Reduced muscle mass and strength Fine facial wrinkles Increased central obesity

Appearance of the Patient

• Patients usually appear fatigued and lethargic and present with weight loss.

Vital Signs

• Bradycardia
• Orthostatic hypotension

Skin

• Pallor
• Areolar Hypopigmentation
• Coarse and dry skin
• Hair loss

HEENT

• Fine wrinkling of face
• Loss of eyebrows laterally

Genitourinary

• Breast tissue atrophy/involution
• Vaginal atrophy

Neuromuscular

• Patient is usually oriented to time, place and person

Extremities

• Pitting edema of the upper/lower extremities (myxedema)
• Muscle wasting
• Delayed relaxation of deep tendon reflexes

References

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