The incidence of Sheehan's syndrome after obstetric hemorrhage

Objective: To estimate the incidence of Sheehan's syndrome in a well-described cohort of patients with obstetric hemorrhage. Design: Retrospective cohort study. Setting: Tertiary care center. Patient(s): Two hundred patients. Intervention(s): Questionnaires were sent to study and comparison patients asking about menstrual dysfunction, lactation difficulty, cold intolerance, fatigue, axillary and pubic hair loss, and secondary infertility. Main Outcome Measure(s): Women who experienced two or more symptoms were referred for hormone testing of insulin-like growth factor 1 (IGF-1), T₄, PRL, and early morning cortisol (F) levels. Result(s): A total of 109 patients responded to the survey, a 55% response rate. Fourteen of 55 (25%) patients in the hemorrhage group identified themselves as suffering from two or more symptoms on the questionnaire. Eight of the 14 patients were tested, but none had hormonal evidence of hypopituitarism. Four of 54 (7%) comparison patients also identified themselves as suffering from two or more symptoms, but neither of the two tested had hormonal evidence of hypopituitarism. Conclusion(s): Among women with postpartum hemorrhage, subsequent development of clinical symptoms does not correlate well with laboratory evidence of hypopituitarism. Clinically significant Sheehan syndrome is an uncommon consequence of obstetric hemorrhage in today's environment.