Shihan Syndrome: Symptoms and Treatment

Shihan's syndrome is a neuroendocrine disorder of health, resulting from the death of a part of the pituitary cells. This situation is provoked by massive blood loss during childbirth or abortion. Symptoms of the disease develop gradually, are associated with inadequate production of various hormones of the pituitary gland. What relation have births or abortions to the death of pituitary cells? Let's try to understand. From this article you can learn why and how Shihan's syndrome develops, how it manifests itself and how it is treated. So, let's get started.

Why and how does Shihan syndrome occur?

Shihan Syndrome develops in women during childbirth or after them.

The pituitary gland is part of the central nervous system, located inside the skull in the Turkish saddle. The pituitary body consists of several parts, each of which produces specific substances - hormones. Hormones get into the blood, are carried with its current throughout the body, and there they reach their point of application: the organs of internal secretion (glands). These are such formations as the thyroid gland, adrenal glands, testicles, ovaries and others.

Hormones of the pituitary gland cause the glands of internal secretion to produce their hormones, which regulate metabolism, growth, sexual function (including reproduction processes) and a number of other processes. It turns out that without hormones of the pituitary gland it is impossible to function the glands of internal secretion of the whole organism. No pituitary hormones - there is no endocrine production of the adrenal gland, thyroid, testes and ovaries.

The pituitary gland is an anatomical formation with a very active blood flow. At the same time, he is very sensitive to the scarcity of blood supply. If massive blood loss occurs, the pituitary gland is deprived, its cells can irreversibly die. Blood loss can occur for various reasons: as a result of injuries, surgical interventions with insufficient correction of the volume of circulating blood, birth. So, if massive blood loss in childbirth (more than 1 liter) or after abortion leads to a lack of blood supply to the pituitary gland and the death of its cells, then there is Shihan syndrome.

Pathology bears the name of the scientist, who in 1937 first established a strategic link between the great loss of blood in labor and the subsequent endocrine problems of the body. I would like to clarify that any massive blood loss is dangerous for the pituitary gland. But Shihan syndrome is a pathology of the pituitary gland, which is associated with blood loss in childbirth and immediately after them (or with abortions).

Here plays an important role. The fact is that during pregnancy the pituitary gland increases in size (due to the need to provide an important function of procreation), and therefore requires more active blood flow. And if in childbirth or after them there is a shortage of blood supply, then this situation turns out to be critical for pituitary cells requiring more nutrients than in the normal state organism. It turns out that blood loss in childbirth is more dangerous for the pituitary gland than blood loss in a normal trauma. Therefore, this situation is identified as a separate disease.

So, in the Shihan syndrome, some of the cells of the pituitary gland are irreversibly destroyed, which means that the production of its hormones decreases (or ceases altogether). Glands of internal secretion are "decapitated they can not perform their function without the leading role of pituitary hormones. The lack of hormone production leads to the appearance of clinical signs of Shihan syndrome.

Symptoms

Clinical manifestations of Shihan syndrome are very versatile. This is due to the fact that the pituitary gland produces several different hormones that regulate various metabolic pathways, the processes of reproduction, growth, and adaptation to changing environmental conditions. The vastness of clinical manifestations will be related to the extent to which the pituitary gland is severely damaged, how many of its cells have died and what hormones they produced. If 60 to 70% of the pituitary cells died, the deficit will be partial, although very palpable. With the death of 90% of cells and more, a total hormone deficiency develops, and Shihan syndrome will have a more severe course.

The risk of developing Shihan's syndrome directly depends on the amount of blood loss: the more blood is lost, the higher the risk of death of the pituitary cells.

Depending on which hormones are not enough, there may be problems with work:

• thyroid gland;
• adrenal glands;
• of the sex glands.

Most often, the symptoms of Shihan syndrome will be combined. The very first and rather specific symptom is the absence of lactation. Normally, the births trigger the production of breast milk (through the formation of prolactin in pituitary gland), and in the case of Shihan's syndrome, it disappears altogether, despite the active application of the child to the chest. If the birth was accompanied by massive blood loss, and then the woman does not have breast milk, then this should alert the doctor with regard to a possible Shihan syndrome.

A woman with Shihan syndrome is gradually losing weight. Weight loss can have different rates, in severe cases amounting to 5 kg per month. Weight loss occurs not only due to the subcutaneous fat layer, but also due to the muscles, reducing internal organs. Man seems to be "drying up". These symptoms are associated with a decrease in the production of growth hormone pituitary.

Deficiency of sex hormones becomes the reason of disturbances of a menstrual cycle. Despite the absence of lactation, menstruation is meager, irregular, painful. Ovulation (the release of the egg from the ovary) does not occur, respectively, infertility is developing. In the end, menstruation ceases altogether. With erased forms of Shihan syndrome, menstruation persists for a long time. The mammary glands decrease in size (atrophy), pigmentation in the nipple and genital area disappears. The hair falls in the armpits and pubic area. Sexual desire is reduced.

The lack of a thyroid-stimulating hormone of the pituitary gland leads to problems with the thyroid gland. Secondary hypothyroidism develops, which is characterized by general weakness, lethargy, poor tolerance of physical and mental loads. Disturbing constant drowsiness, a feeling of chilliness, motor activity is reduced. Body temperature becomes less than 3, ° C. The liquid is retained in the body, which leads to swelling, puffiness (with pronounced exhaustion there is no edema). There are problems with peristalsis of the intestine: constipation and atony of the gastrointestinal tract develop.

If the deficiency of thyroid-stimulating hormone is combined with a deficiency of adrenocorticotropic hormone (function regulator adrenal glands), then there is a decrease in blood pressure (hypotension), the frequency of cardiac abbreviations. Resistance to any stressful situation is reduced. Any disease or trauma (even minor) is difficult to tolerate, accompanied by the development of complications. Reduction of blood pressure can be so significant that it leads to collapse (in extremely difficult cases with the transition to coma).

In addition to these signs, it can be said that premature aging of the organism occurs. This is expressed in brittle, graying and hair loss, destruction of tooth enamel, loss of teeth, the development of pigment spots on the skin, the separation of nails. The skin becomes dry, scaly, wrinkled, pale. The production of sebum and sweat glands decreases. A deficiency of calcium develops, which leads to fragility and brittleness of bones, fractures from minor injuries are possible.

Syndrome Shihana is accompanied by a decrease in mental abilities and memory impairment. In severe cases of total hormone deficiency and with the long-term existence of the syndrome, the situation can go as far as marasmus.

Another symptom of Shihan syndrome is anemia (a decrease in the number of red blood cells and hemoglobin), which is difficult to treat.

Depending on the severity of symptoms in medicine, it is common to identify several forms of severity of Shihan syndrome:

1. mild (headache, general weakness, fast fatigue, propensity to edema, drowsiness, lowering blood pressure, minor problems with the menstrual cycle);
2. moderate severity (marked decrease in blood pressure with a tendency to fainting and collapse, hypothyroidism, skin and hair problems, small weight deficit and so on);
3. severe (severe problems in the genital area, significant loss of weight before cachexia, anemia, baldness, pronounced weakness until immobility).

Treatment

Shihan's syndrome is treated with replacement therapy. Simply put, the replenishment of missing hormones is made by their analogues from the outside. The earlier treatment is started, the less harmful effects on the body. In time the exposed diagnosis allows to avoid catastrophic weight loss, alopecia, atrophy of the dairy and sex glands and so on.

The main drugs of substitution therapy for Shihan syndrome are:

• glucocorticoids;
• sex hormones and gonadotropins;
• thyroid hormones.

Of glucocorticoids most often used Prednisolone and Hydrocortisone. So, for example, prednisolone is prescribed for 5 mg in the morning and at lunch for a month, then after a short break the course is repeated again. Another scheme for the use of prednisolone is possible.

Sex hormones are usually prescribed as combined drugs, usually used for hormonal contraception (Lindineth, Yarina, Logest, Marvelon, Norkolut and others). Such preparations contain both estrogens and progesterone, therefore, using one pill, the deficiency of the entire complex of the sex hormones of a woman is filled.

To compensate for the deficiency of thyroid hormones, L-thyroxine is used. Begin with a dose of 1, -25 μg per day, then gradually increase the dose. The required therapeutic dose is determined individually, controlled by indicators of blood pressure, heart rate and some others. You should know that thyroid hormone preparations can not be prescribed before the correction of adrenal hormones, that is, glucocorticoids. If there is a need for correction of both hormones of the adrenal glands and thyroid hormones, then at the beginning prescribe glucocorticoids, and only when their deficiency is partially replenished, begin to use hormones thyroid gland. Why do they do this? The fact is that the primary use of thyroid hormones threatens the emergence of acute adrenal insufficiency in conditions of deficiency of glucocorticoids, and this condition already threatens life patient.

In addition to the above drugs, you may need anabolic steroids (when weight loss has gone too far). These are such medicines as Retabolil (Nandrolone), Methandriol. Of course, nutrition at the same time should be full, balanced and maximally vitaminized, to allow drugs to fully realize their function.

For the treatment of anemia, iron preparations are used (Sorbifer Durules, Totema, Fenyuls, Tardiferon, Aktiferrin). Sometimes, in order to restore normal blood counts, these drugs should be consumed for a long time.

Also, with Shihan's syndrome, vitamins of all groups, preparations that improve metabolism and energy supply of tissues (Mildronate, Riboxin, ATP, Levocarnitine and others), means that increase the body's immune forces (Aloe extract, FBS, tincture of ginseng, magnolia vine, eleutherococcus and so on Further).

Severe cases of Shihan syndrome with the development of cachexia, immobility are treated in hospital with the help of injectable forms of drugs (the same hormones, vitamins, fortifying agents). After the improvement of the condition, such patients are transferred to tablet formulations.

Permanent replacement therapy for Shihan syndrome contributes to the disappearance of the symptoms of the disease and return to a full life.

Thus, Shihan's syndrome is a disease that can occur after massive gynecological blood loss. The disease can not manifest itself immediately, only the absence (or disappearance) of breast milk in the early postpartum period can serve as the first adverse bell. Other manifestations appear within a few months (sometimes - years). In general, the disease manifests itself as endocrine disorders and requires replacement therapy for missing hormones. Success in the fight against the disease depends on the timeliness of seeking medical help. The introduction of missing hormones from the outside can eliminate all the symptoms of Shihan syndrome.