Epidemiology

Etiology

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

Hypopituitarism refers to deficiency of one or more anterior pituitary hormones
- GH deficiency → growth retardation (during childhood), ↓ bone density, muscle atrophy, hypercholesterolemia
- Prolactin deficiency → lactation failure following delivery
- FSH/LH deficiency → hypogonadotropic hypogonadism (secondary hypogonadism)
- TSH deficiency → secondary hypothyroidism
- ACTH deficiency → secondary adrenal insufficiency
In addition to the aforementioned hormone deficiencies, patients with severe pituitary damage (panhypopituitarism) also present with deficiencies of posterior pituitary hormones:
- ADH deficiency → central diabetes insipidus
- Oxytocin deficiency → no effect

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