Chhotu Ram Hospital, India
Deepti Jain is a Consultant, M.D. Obstetrician and gynecologist. She is a Pioneer in insertion of LNG IUS and received various Gold Medals in Physiology and Surgery. Her Chief interests are -PCOS, Thyroid disorders, Hypopitiutarism, Hirsutism and related endocrinology. She is trying to deliver the latest innovations to rural women at door step. She Published several articles in national and international journals, and won best paper award in conference,at AIIMS, New Delhi. Her recent Publications are on Sheehan’s syndrome, Perineal scar Endometriosis, Classic congenital adrenal hyperplasia, USA Caeserean Scar Pregnancy managed by Scar resection January 2014.
Global Burden Disease (GBD) (1990) lists sequelae for postpartum haemorrhage as Sheehan’s Syndrome and postpartum anemia. However in year 2000, only postpartum anemia was considered by GBD as a fallout of postpartum haemorrhage. However in developing countries , Sheehan’s Syndrome is still visible and early recognition is important to prevent morbidity in young women. Serious Obstetric haemorrhage results in pan hypopitutarism or selective hormone deficiency. The probable etiology is an infarction of the enlarged pituitary gland of pregnancy. Growth hormone and prolactin deficiency is seen in 90-100 % of cases and cortisol Gonadotrophin and thyroid stimulating hormones are decreased in 80-100 % of cases; sudden cortisol deficiency often results in circulatory collapse. Diabetes insipidus has also been reported. Anomalous presentations with hyper prolactinemia have also been found in Sheehan’s after a literature review ; although rare. Empty Sella sign on Magnetic resonance imaging is classically present in Sheehan’s Syndrome. However a Microprolactinoma was observed in this institution. Three cases have been of Sheehan’s Syndrome were diagnosed in this hospital in last 3 years, while none in preceding 22 years . Early recognition of these cases was probably because of better knowledge of Gynecological Endocrinology in recent times. The treatment of Sheehan’s Syndrome lies in the replacement of deficient hormones. Cyclic Estrogen and Progesterone is necessary to reverse genital atrophy and maintain bone mineral density. If fertility is desired, Ovulation induction is performed with Human Menopausal Gonadotrophins . Recombinant Follicle Stimulating hormone with varying doses of Luteinizing hormone can also be used.