Overview
Definition
Postpartum pituitary necrosis secondary to severe obstetric hemorrhage and hypovolemic shock, leading to panhypopituitarism.
Epidemiology
Rare in developed countries due to modern obstetric care; more common in developing regions.
Etiology & Risk Factors
- Ischemic necrosis of the anterior pituitary gland, which hypertrophies during pregnancy and is highly susceptible to hypoperfusion
Clinical Symptoms
- Failure to lactate (due to prolactin deficiency)
- Amenorrhea or oligomenorrhea (gonadotropin deficiency)
- Fatigue, weight loss, hypotension (ACTH/TSH deficiency)
- Loss of pubic and axillary hair
Clinical Approach
Diagnosis
- Low pituitary hormones (FSH, LH, TSH, ACTH, GH, Prolactin) with low target hormones
- MRI showing 'empty sella' or pituitary atrophy in chronic cases
Management
- Lifelong hormone replacement therapy (Hydrocortisone, Levothyroxine, Estrogen/Progesterone, Growth Hormone)
Complications
- Adrenal Crisis (life-threatening)
- Myxedema coma
- Severe hypoglycemia