Demonstration of reserved anterior pituitary function among patients with amenorrhea after postpartum hemorrhage

To demonstrate the residual pituitary function of patients with Sheehan's s yndrome years after the obstetric complication, 14 patients with postpartum hemorrhage followed by secondary amenorrhea and agalactia were included in this review. Due to their unfamiliarity with the clinical symptoms, these patients did not receive pretreatment hormonal therapy. The mean age at the ir last delivery war 29 years (range 21-38 years). The mean duration betwee n postpartum hemorrhage and the subsequent clinical manifestations leading to the endocrine investigation was 18 years (range 1-33 years). Eight patients presented with symptoms of severe hyponatremia (serum sodium less than 125 mmol/l) more than 16 years (mean 23 +/- 10) after the occurr ence of postpartum hemorrhage. The electrolyte abnormality was primarily du e to adrenal dysfunction. Seven out of 14 patients had normal basal luteini zing hormone (LH) levels and adequate LH responses to gonadotropin releasin g hormone stimulation, Administration of thyrotropin releasing hormone prov oked thyrotropin release and/or prolactin secretion in Jour cases. The mani festation of clinical hypopituitarism and the degree of empty sella an comp uted tomography scanning did not accurately indicate the secreting ability of the pituitary in patients with Sheehan's syndrome. Although all the patients had amenorrhea, the gonadotropic functions of the pituitary still remain in some patients. Various degrees of other pituitar y functions can also been demonstrated even several decades after the occur rence of obstetric complications. Our data suggest that the amenorrhea of S heehan's patients is not simply due to a dysfunction of the pituitary gonad otrophs.