Sheehan syndrome vs Empty sella syndrome
How to tell Sheehan syndrome and Empty sella syndrome apart when a board question makes them look alike.
Sheehan is postpartum ischemic hypopituitarism with failure to lactate; empty sella is imaging-defined CSF-filled sella with flattened pituitary.
Side by side
Postpartum pituitary infarction after severe obstetric hemorrhage causing failure to lactate, amenorrhea, fatigue, hypotension, and hypopituitarism.
CSF-filled enlarged sella with flattened pituitary, often incidental or associated with headaches and variable pituitary function.
Pregnancy enlarges the pituitary, making it vulnerable to ischemic necrosis during postpartum shock or hemorrhage.
Herniation of subarachnoid space into the sella compresses or flattens pituitary tissue without an ischemic postpartum trigger.
Low prolactin after delivery, low pituitary hormones, and history of postpartum hemorrhage support Sheehan syndrome.
Imaging showing CSF-filled empty sella with flattened pituitary supports empty sella syndrome.
The trap
Both involve pituitary dysfunction, and Sheehan-type infarction can later evolve into secondary empty sella on imaging; the postpartum-hemorrhage history is what anchors Sheehan syndrome.
The repair move
For pituitary failure, ask whether the trigger was postpartum hemorrhage or an empty sella imaging finding.
Try a free question
CoreA woman has severe postpartum hemorrhage requiring transfusion. Weeks later she cannot lactate and has amenorrhea, fatigue, hypotension, and low anterior pituitary hormones. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Sheehan syndrome. Postpartum hemorrhage followed by failure to lactate and hypopituitarism points to Sheehan syndrome.
Why the other choices are tempting
- B. Empty sella syndrome is an imaging pattern with CSF-filled sella, not postpartum infarction.
- C. Prolactinoma raises prolactin rather than causing failure to lactate from low prolactin.
- D. Pituitary apoplexy is acute hemorrhage or infarction in a pituitary tumor with sudden headache/visual symptoms.
- E. Primary ovarian insufficiency raises gonadotropins and does not explain low multiple pituitary hormones.
Flashcards
Tap a card to flip it.
What postpartum clue points to Sheehan syndrome?
Severe postpartum hemorrhage followed by failure to lactate points to Sheehan syndrome.
Why is prolactin low in Sheehan syndrome?
Pituitary infarction destroys lactotroph function, impairing postpartum milk production.
Quick answers
What is the fastest way to tell Sheehan syndrome from Empty sella syndrome?
Sheehan is postpartum ischemic hypopituitarism with failure to lactate; empty sella is imaging-defined CSF-filled sella with flattened pituitary.
What is the key clue for Sheehan syndrome?
Postpartum pituitary infarction after severe obstetric hemorrhage causing failure to lactate, amenorrhea, fatigue, hypotension, and hypopituitarism.
What is the key clue for Empty sella syndrome?
CSF-filled enlarged sella with flattened pituitary, often incidental or associated with headaches and variable pituitary function.
What is the common trap with Sheehan syndrome vs Empty sella syndrome?
Both involve pituitary dysfunction, and Sheehan-type infarction can later evolve into secondary empty sella on imaging; the postpartum-hemorrhage history is what anchors Sheehan syndrome.