Case 20 :  
A young female (post-partum) presents with headache and vomiting. MRI is done.
What is the diagnosis?

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Imaging Findings
Study shows a small atrophic pituitary gland in a normal-size sella.

Sheehanís Syndrome

Sheehan's Syndrome, in the purest sense, is hypopituitarism due to pituitary infarction that occurs at the time of obstetrical hemorrhage and consequent low blood pressure. The term has, however, been used by some to connote hypopituitarism due to any type of pituitary infarction.

During a pregnancy, the pituitary doubles in size. This doubling is due to an increase in a number of prolactin-producing cells. The pituitary is much more metabolically active and demands more blood supply. Any insult that threatens the blood pressure, such as bleeding during childbirth, can result in decreased pituitary function due to death of cells due to the lack of oxygen. Hemorrhage in the pituitary can also occur. Many patients are unable to breastfeed their children in the postpartum because prolactin levels fall. Other Sheehan's Syndrome patients fail to regain their periods after childbirth. Some patients develop symptoms and signs of pituitary dysfunction immediately while others do not come to medical attention for years because their pituitary function is partially preserved. Patients may lose one or more of their pituitary hormones and either one of these may be either partially or completely missing by the time they come to medical attention.




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Dr. Deepak Patkar, MRI Centre, Nanavati Hospital, Mumbai