Diagnosis

Diagnosing Sheehan's syndrome can be difficult. Many of the symptoms overlap with those of other conditions. To diagnose Sheehan's, your doctor likely will:

  • Collect a thorough medical history. It's important to mention any childbirth complications you've had, no matter how long ago you gave birth. Also, be sure to tell your doctor if you didn't produce breast milk or you failed to start menstruating after delivery — two key signs of Sheehan's syndrome.
  • Run blood tests. Blood tests will check your pituitary hormone levels.
  • Request a pituitary hormone stimulation test. You might need stimulation testing of the pituitary hormones, which involves injecting hormones and running repeated blood tests to see how your pituitary responds. This test is typically done after consulting a doctor who specializes in hormonal disorders (endocrinologist).
  • Request imaging tests. You might also need imaging tests, such as an MRI scan or CT scan, to check the size of your pituitary and to look for other possible reasons for your symptoms, such as a pituitary tumor.

Treatment

Treatment for Sheehan's syndrome is lifelong hormone replacement therapy for the hormones you're missing. Your doctor might recommend one or more of the following medications:

  • Corticosteroids. These drugs, such as hydrocortisone or prednisone, replace the adrenal hormones that aren't being produced because of an adrenocorticotropic hormone (ACTH) deficiency.

    You'll need to adjust your medication if you become seriously ill or undergo major physical stress. During these times, your body would ordinarily produce extra cortisol — a stress hormone. The same kind of dosage fine-tuning may be necessary when you have the flu, diarrhea or vomiting, or have surgery or dental procedures.

    Adjustments in dosage might also be necessary during pregnancy or with marked weight gain or weight loss. Avoiding doses higher than you need can help avoid the side effects associated with high doses of corticosteroids.

  • Levothyroxine (Levoxyl, Synthroid, others). This medication boosts deficient thyroid hormone levels caused by low or deficient thyroid-stimulating hormone (TSH) production.

    If you change brands, let your doctor know to ensure you're still receiving the right dosage. Also, don't skip doses or stop taking the drug because you're feeling better. If you do, signs and symptoms will gradually return.

  • Estrogen. This includes estrogen alone if you've had your uterus removed (hysterectomy) or a combination of estrogen and progesterone if you still have your uterus.

    Estrogen use has been linked to an increased risk of blood clots and stroke in women who still make their own estrogen. The risk should be less in women who are replacing missing estrogen.

    Preparations containing luteinizing hormone (LH) and follicle-stimulating hormone (FSH), also called gonadotropins, might make future pregnancies possible. These can be administered by injection to stimulate ovulation.

    After age 50, around the time of natural menopause, discuss the risks and benefits of continuing to take estrogen or estrogen and progesterone with your doctor.

  • Growth hormone. Some studies have shown that replacing growth hormone in women with Sheehan's syndrome — as well as in adults with other forms of hypopituitarism — can help normalize the body's muscle-to-fat ratio, maintain bone mass, lower cholesterol levels and improve overall quality of life. Side effects might include joint stiffness and fluid retention.

Your endocrinologist is likely to test your blood regularly to make sure that you're getting adequate — but not excessive — amounts of hormones. Generally, hormone levels are checked every few months at the beginning of treatment and then once a year thereafter.

Preparing for your appointment

If your primary care provider suspects Sheehan's syndrome, you'll likely be referred to a doctor who specializes in hormonal disorders (endocrinologist).

Here's information to help you get ready for your appointment:

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:

  • Your symptoms, even if they seem unrelated to each other, and when they began
  • Key personal information, including recent surgical procedures and other major stresses, and your family medical history
  • All medications, vitamins or other supplements you take, including doses
  • Questions to ask your doctor

Bring medical records from previous pregnancies, especially those on labor and delivery. Take a family member or friend along, if possible, to help you remember the information you're given.

For Sheehan's syndrome, basic questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • What tests do I need?
  • Is Sheehan's syndrome temporary, or will I always have it?
  • Will I be able to have another child?
  • What treatments are available, and what do you recommend?
  • I have other health conditions. How can I best manage them together?
  • Are there dietary or activity restrictions I need to follow?
  • Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

  • Did you bleed heavily after your delivery?
  • Did you have other complications during childbirth?
  • Do you have symptoms all the time, or do they come and go?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • Does anything seem to make your symptoms worse?
Nov. 22, 2016
References
  1. DeCherney AH, et al. Thyroid & other endocrine disorders during pregnancy. In: Current Diagnosis & Treatment Obstetrics & Gynecology. 11th ed. New York, N.Y.: The McGraw-Hill Companies; 2013. http://www.accessmedicine.com. Accessed Oct. 2, 2016.
  2. Pituitary gland. Hormone Health Network. http://www.hormone.org/hormones-and-health/endocrine-glands-and-types-of-hormones/pituitary-gland. Accessed Oct. 2, 2016.
  3. Ferri FF. Sheehan syndrome. In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed Oct. 2, 2016.
  4. Sheehan syndrome. Genetic and Rare Diseases Information Center. https://rarediseases.info.nih.gov/diseases/7630/sheehan-syndrome. Accessed Oct. 1, 2016.
  5. Snyder PJ. Treatment of hypopituitarism. http://www.uptodate.com/home. Accessed Oct. 1, 2016.
  6. Belfort MA. Overview of postpartum hemorrhage. http://www.uptodate.com/home. Accessed Oct. 1, 2016.
  7. Snyder PJ. Causes of hypopituitarism. http://www.uptodate.com/home. Accessed Oct. 1, 2016.
  8. DeCherney AH, et al. Thyroid & other endocrine disorders during pregnancy. In: Current Diagnosis & Treatment Obstetrics & Gynecology. 11th ed. New York, N.Y.: The McGraw-Hill Companies; 2013. http://www.accessmedicine.com. Accessed Oct. 2, 2016.
  9. Pituitary gland. Hormone Health Network. http://www.hormone.org/hormones-and-health/endocrine-glands-and-types-of-hormones/pituitary-gland. Accessed Oct. 2, 2016.
  10. Ferri FF. Sheehan syndrome. In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed Oct. 2, 2016.
  11. Sheehan syndrome. Genetic and Rare Diseases Information Center. https://rarediseases.info.nih.gov/diseases/7630/sheehan-syndrome. Accessed Oct. 1, 2016.
  12. Snyder PJ. Treatment of hypopituitarism. http://www.uptodate.com/home. Accessed Oct. 1, 2016.
  13. Belfort MA. Overview of postpartum hemorrhage. http://www.uptodate.com/home. Accessed Oct. 1, 2016.
  14. Snyder PJ. Causes of hypopituitarism. http://www.uptodate.com/home. Accessed Oct. 1, 2016.