Sheehan syndrome: postpartum necrosis of the pituitary gland. Usually occurs following postpartum hemorrhage, but can also occur even without clinical evidence of hemorrhage.
During pregnancy, hypertrophy of prolactin-producing regions increases the size of the pituitary gland, making it very sensitive to ischemia.
Blood loss during delivery/postpartum hemorrhage → hypovolemia → vasospasm of hypophyseal vessels → ischemia of the pituitary gland → empty sella turcica on imaging
Pathophysiology
Hypopituitarism refers to deficiency of one or more anterior pituitary hormones
In addition to the aforementioned hormone deficiencies, patients with severe pituitary damage (panhypopituitarism) also present with deficiencies of posterior pituitary hormones:
Treat the underlying cause: For example, surgical resection of a pituitary adenoma.
Hormone Replacement Therapy: This is the cornerstone of treatment and is typically lifelong.
Glucocorticoids (hydrocortisone, prednisone): Replace for ACTH deficiency. This must be done FIRST before thyroid hormone replacement to prevent precipitating a life-threatening adrenal crisis.
Levothyroxine: Replace for TSH deficiency.
Sex Hormones: Testosterone for men; estrogen and progesterone for women.
Growth Hormone (somatropin): Used for children with GH deficiency and may be used in adults to improve body composition and quality of life.
Desmopressin (DDAVP): Used if there’s concomitant posterior pituitary damage leading to diabetes insipidus.