USMLE/COMLEX - Step 2 - Sheehan Syndrome

USMLE/COMLEX - Step 2 - Sheehan Syndrome The pathophysiology Sheehan syndrome involves damage or destruction of the pituitary gland, resulting in decreased or absent hormone production. The most common cause of Sheehan syndrome is postpartum hemorrhage leading to ischemic pituitary gland necrosis. In addition, it can occur when excess Severe fatigue and weakness Abdominal pain Nausea and vomiting Confusion or delirium Low blood pressure Rapid heartbeat Dehydration Loss of consciousness Hypotension Bradycardia Pale or dry skin Delayed reflexes Loss of pubic or underarm hair Thyroid enlargement Slow growth or delayed puberty in children Hormone level measurements such as ACTH, TSH, GH, FSH, LH, and prolactin ACTH stimulation test MRI scan Water deprivation test Insulin tolerance test Thyroid function tests The management of Sheehan syndrome, also known as hypopituitarism, involves hormone replacement therapy to replace the deficient hormones and manage any associated complications. The specific management plan will depend on which hormones are affected and the severity of the hormone deficiency. Some common management strategies for Sheehan syndrome: 1. Hormone replacement therapy: The primary treatment for Sheehan syndrome is to replace the deficient hormones. Depending on the affected hormones, hormone replacement therapy may include glucocorticoids, thyroid hormone, estrogen and progesterone replacement therapy, growth hormone, and testosterone replacement therapy. 2. Management of adrenal insufficiency: Patients with Sheehan syndrome who have adrenal insufficiency may need to take glucocorticoid medications, such as hydrocortisone or prednisone, to replace the missing cortisol. 3. Management of hypothyroidism: Patients with Sheehan syndrome who have hypothyroidism may need to take thyroid hormone replacement therapy, such as levothyroxine, to replace the missing thyroid hormone. 4. Management of hypogonadism: Women with Sheehan syndrome may need estrogen and progesterone replacement therapy to replace the missing sex hormones. Men with Sheehan syndrome who have hypogonadism may need to take testosterone replacement therapy. 5. Management of growth hormone deficiency: Patients with Sheehan syndrome who have growth hormone deficiency may need to take growth hormone replacement therapy to stimulate growth and improve bone density. 6. Monitoring and managing associated complications: Patients with Sheehan syndrome may be at increased risk of osteoporosis, anemia, and hypoglycemia. Regular monitoring and management of these complications may be necessary.