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Congenital adrenal hyperplasia
Primary adrenal insufficiency
Adrenal cortical carcinoma
Thyroglossal duct cyst
Thyroid eye disease (NORD)
Toxic multinodular goiter
Euthyroid sick syndrome
Subacute granulomatous thyroiditis
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Autoimmune polyglandular syndrome type 1 (NORD)
Multiple endocrine neoplasia
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Adrenal insufficiency: Pathology review
Adrenal masses: Pathology review
Hyperthyroidism: Pathology review
Hypothyroidism: Pathology review
Thyroid nodules and thyroid cancer: Pathology review
Parathyroid disorders and calcium imbalance: Pathology review
Diabetes mellitus: Pathology review
Cushing syndrome and Cushing disease: Pathology review
Pituitary tumors: Pathology review
Hypopituitarism: Pathology review
Diabetes insipidus and SIADH: Pathology review
Multiple endocrine neoplasia: Pathology review
Neuroendocrine tumors of the gastrointestinal system: Pathology review
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Sheehan syndrome after p. 351
Sheehan syndrome and p. 351
Brittany Norton, MFA
Jahnavi Narayanan, MBBSYifan Xiao, MD
Sheehan’s syndrome, is also sometimes called postpartum pituitary gland necrosis, and we can break that down.
Postpartum refers to the time after a mother gives birth to an infant, pituitary gland refers to a tiny gland that is at the base of the brain, and necrosis refers to death.
So, postpartum pituitary gland necrosis is a disorder where cells in a pituitary gland of a new mother start to die - most commonly because excess blood loss during childbirth leaves those cells without adequate blood flow. It is a rare type of pituitary apoplexy.
During pregnancy, a group of cells in the pituitary gland called lactotrophs start to increase in size and number.
These lactotrophs secrete the hormone prolactin, and the increased levels of prolactin prepares the mammary glands to produce milk.
Even though there are more lactotrophs that are larger and more metabolically active, the blood supply to the pituitary gland remains the same.
So there is an increased demand without an increase in supply, means the lactotrophs are hypoperfused.
In other words, the lactotrophs are just barely getting by, and if they get any less blood, than they face ischemic injury and necrosis or death.
What’s even more alarming is that since there are more metabolically active lactotrophs around, they take up a larger proportion of the blood that supplies the pituitary, increasing the risk of ischemia in other cells of the pituitary gland as well.
During the delivery of an infant, excessive blood loss is called postpartum hemorrhage.
Postpartum hemorrhage is generally defined as losing more than 500ml of blood after a vaginal delivery or more than 1000ml after a cesarean section delivery.
Sheehan syndrome, also known as postpartum hypopituitarism, is a condition that affects women who have experienced postpartum hemorrhage (PPH). PPH causes ischemia to lactotrophs and other cells of the pituitary, causing them. This results in deficiencies of prolactin, growth hormone, thyroid stimulating hormone, adrenocorticotropic hormone, luteinizing hormone, and follicle-stimulating hormone.
During pregnancy, pituitary cells increase in size and number, taking up more blood than usual. So, when there is PPH, these cells are prone to starve and become ischemic. An early symptom of Sheehan syndrome is agalactorrhea, whereas late symptoms include amenorrhea, low blood pressure, low blood sodium, and glucose levels, fatigue, and muscle loss. Sheehan's syndrome can be treated by replacing the deficient hormones, usually for a person's entire life.
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