Sheehan syndrome

I created this video with the YouTube Video Editor (http://www.youtube.com/editor)

- You know, when most of
us think of pregnancy,

we focus down here at
what's going on at the

level of the uterus, but
a healthy pregnancy has

a lot to do with a properly functioning

pituitary gland up here in the brain.

The pituitary gland makes the hormones

that are essential for life,
and in pregnancy it grows.

And not just by a little
but by close to 150%.

A lot of that growth is due
to cells call lactotrophs.

These cells in the pituitary gland called

lactotrophs increasing in number.

Lactotrophs are these cells that

make a hormone called prolactin.

They make this hormone called prolactin.

Prolactin stimulates breast growth and

milk production, so as you can imagine,

it's really important during pregnancy.

That's all good but the problem is

that while the pituitary gland grows

substantially during
pregnancy, the blood supply

to the pituitary doesn't
increase by as much.

That kind of looks like this where

if this is a normal pituitary gland,

this is what a normal
pituitary gland looks

like, and this is its blood supply.

In pregnancy, this gland is way bigger,

is way bigger.

But, its blood supply
isn't that much greater.

Throughout the pregnancy,
I guess you can say that

the pituitary gland is in
a really fragile state.

It's only receiving as
much blood as it needs.

No more than that.

It's really pretty susceptible to being

in a situation where its blood supply

doesn't meet its requirements,

which can lead to ischemia,
or a lack of oxygen supply.

Eventually it can lead to death

of the cells of the pituitary gland.

That death of the cells
in the pituitary gland

is referred to as Sheehan Syndrome.

The topic of this video.

When do we have to
worry about all of that?

We have to worry about it in any

case of excessive blood loss.

Any sort of trauma
resulting in blood loss or

in the case of postpartum hemorrhage,

which refers to when you have

an excessive blood loss during delivery.

In those cases the pituitary gland isn't

able to withstand that
loss in blood supply.

In addition to that,
remember that whenever

you have a loss of blood volume,

whenever you have a loss of blood volume,

the blood pressure in the body drops.

The body responds to that
dip in blood pressure

by clamping down on all
of the blood vessels,

which is referred to as vasoconstriction.

The body repsonds to the
dip in blood pressure

by vasoconstricting to
increase the blood pressure.

That clamping down on the blood vessels

of the pituitary further
reduces the amount

of blood that's going
into the pituitary gland.

In situations of acute blood loss, again

such as in trauma or a
postpartum hemorrhage,

you can have death of the pituitary cells.

What does that mean?

Why is that significant if you

have death of the pituitary cells?

Firstly, keep in mind that this

isn't an all or none type of picture.

You can have death of

a few, many, or all of the cells.

Usually it's just the
lactotrophs that die.

In which case you end up
with a prolactin deficiency.

Because of that, if you
have a prolactin deficiency,

the breasts will reduce in size

and the mom isn't able to
breastfeed after delivery.

Usually, this is actually how
this syndrome is discovered.

The mom isn't able to breastfeed after

delivery and that warrants
investigation into

the cause of why that's happening.

You can have the death of the lactotrophs.

You can also have death of the cells

that make hormones involved
in the reproductive axis.

That could lead to a lack of menstruation

or an inability to
regrow shaved pubic hair

or axillary or underarm hair.

Or less commonly but still possible,

you can have loss of all of the cells

of the pituitary gland and that could

lead to symptoms of low thyroid hormone

such as, weight gain, cold intolerant,

and you can also have symptoms of

cortisol deficiency which could lead to

fatigue or feeling tired, or even

life threatening low blood pressure.

The main treatment for Sheehan Syndrome is

replacing these hormones that you've lost

at the levels that the body
would normally make them.

We're getting better and better

at preventing this disease
from occurring all together.

Nowadays, we take simple measures to

make sure that if the mom suffers,

any form of acute blood loss, we replace

that blood volume as quickly as we can.

That's a little bit of
information on Sheehan Syndrome.