Snapshot A 25-year-old woman presents with her 4-day-old girl, born at full-term via spontaneous vaginal delivery complicated by postpartum hemorrhage, for a follow-up pediatric visit. She reports that she has not been breastfeeding, as her milk never “came in.” She has been feeding only with formula. (Sheehan syndrome) Introduction Introduction clinical definition hypopituitarism ↓ secretion of pituitary hormones etiologies pituitary adenoma craniopharyngioma brain damage radiation therapy Sheehan syndrome empty sella syndrome pituitary apoplexy Studies morning serum levels of pituitary hormones insulin-like growth factor luteinizing hormone (LH) follicle-stimulating hormone (FSH) sex steroids testosterone estradiol thyroid-stimulating hormone (TSH) free thyroxine (T4) cortisol adrenocorticotropic hormone (ACTH) prolactin Treatment hormone replacement therapy corticosteroids sex steroids growth hormone thyroxine Sheehan Syndrome Sheehan syndrome definition pituitary infarction due to postpartum bleeding pathogenesis pregnancy causes increased pituitary size, predisposing the gland to hypoperfusion and ischemia secondary to hypovolemic shock from postpartum bleeding Presentation prolactin deficiency breast involution and failure to lactate amenorrhea hypothyroidism cold intolerance Imaging head magnetic resonance imaging (MRI) infarction of pituitary gland Empty Sella Syndrome Empty sella syndrome definition atrophy or compression of the pituitary gland pathogenesis often idiopathic risk factors obesity female associated conditions idiopathic intracranial hypertension Presentation headache fatigue may be asymptomatic Imaging head MRI pituitary fossa is replaced with cerebrospinal fluid rather than tissue Treatment often do not require treatment if asymptomatic Pituitary Apoplexy Pituitary apoplexy definition hemorrhage or infarction of pituitary gland often in the setting of an existing pituitary adenoma demographics male > female adults Presentation sudden-onset severe headache visual disturbance bilateral hemianopia diplopia altered mental status Imaging head computed tomography (CT) intrasellar mass with hemorrhage Treatment corticosteroids may require surgery