Sheehan's syndrome: A marker for underdevelopment

Abstract

Background: Sheehan’s syndrome is a cause of hypopituitarism and occurs when there is postpartum pituitary necrosis due to hypovolemic shock resulting from massive hemorrhage.

Purpose: to obtain information on new diagnostic and therapeutic approaches in developed or underdeveloped countries, on historical data, clinical manifestations, diagnosis, etiopathogenesis, epidemiology, treatment and prognosis of Sheehan’s Syndrome.

Methodology: To prepare this narrative review, a literature search was carried out in the PubMed, Google Scholar, Lilacs and Scielo databases using the terms noted as keywords; and the review of the list of references (in “snowball”) of the selected studies.

Results: The largest series come from countries like India and China, some from Latin America, although there are also others from developed countries. Those originating in Africa do not show the real problem, since many patients die without going to the hospital, or remain under the management of shamans. At the time of diagnosis, the clinic is usually florid. There is only one study in India that explores prevalence, and there are smaller series, but with well-studied cases, with current technology. In developed countries, prevention is done by providing the best possible obstetric care.

The differential diagnosis is made between hypopituitarism, psychiatric manifestations, hyponatremia, severe hypoglycemia, diabetes insipidus, coagulation or autoimmunity problems, in addition to the clinical presence of classic hormonal deficiencies, acting quickly in the rare acute cases. The publication of clinical cases with some special characteristics is still observed.

Conclusions: Sheehan’s syndrome, although rare, can be seen in some women with a history of massive postpartum hemorrhage. The diagnosis is often made late, when patients have symptomatic hormonal deficiency, so they must be given replacement therapy, to improve quality of life and avoid risk of death.