Sheehan’s Syndrome Presenting as Postpartum Psychosis

Abstract

Sheehan's syndrome is characterized by hypopituitarism following ischemic necrosis of the pituitary gland caused by postpartum hemorrhage and impaired blood supply to the enlarged pituitary gland during pregnancy. The worldwide prevalence has since decreased due to improvements in obstetric care. Behavioral change is a rare presentation and is often misdiagnosed and managed as psychosis. We report a 42-year-old woman presenting with behavioral changes associated with postpartum failure of lactation and amenorrhea. Hormonal work-up revealed panhypopituitarism;

Postpartum Psychosis: A Review of Risk Factors, Clinical Picture, Management, Prevention, and Psychosocial Determinants

“…In rare cases, psychosis accompanies Sheehan syndrome. It is assumed that low levels of cortisol, estrogen, and thyroid hormones contribute to the development of psychosis in this syndrome [ 112 – 117 ], which can occur immediately in the postpartum period or several years after the baby is born [ 118 , 119 ]. The most common symptoms include lack of lactation and menstruation and a history of postpartum hemorrhage.…”

“…The most common symptoms include lack of lactation and menstruation and a history of postpartum hemorrhage. Patients may experience anemia, hyponatremia, hypoglycemia, behavioral disorders, and decreased bone mineral density [ 114 , 117 , 118 ]. MRI shows pituitary involution of varying severity [ 118 , 120 ].…”

“…Among behavioral disorders in patients with Sheehan syndrome, delusions and hallucinations, depression, aggressive behavior, and insomnia can be observed. These are due to the hormonal disorders present, which may subside after properly selected treatment [ 112 , 113 , 117 , 120 ].…”