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Suggest treatment for Sheehan Syndrome

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Internal Medicine Specialist
Practicing since : 1980
Answered : 1357 Questions
I'm having a bunch of problems that I feel that my current family doctor pushes aside due to my age. I am a 24 year old female, DOB XXXXXXX 14, 1990. I have two living children and have had one miscarriage (completely natural). I have no stitches and each delivery was under 10 minutes (9 for the first, 7 for the second). The youngest just turned a year old. Since her birth I have had health troubles that I haven't been able to ignore. They left pieces of the afterbirth which caused hemorrhaging. After that, they implanted the Mirena IUD. I still have random spotting but it's more or less subsided. Have the following issues: Dizziness - where it feels like I'm about to faint and everything gets blurry for a second. Happens a few times in a day. Vision issues - I have had A LOT More tunnel vision / blurred vision than normal. No specific times and nothing in particular triggering it that I know of.. it just happens. And I can't help but space out sometimes and it takes a few minutes to zone back in. Abdominal pain - I was having a lot of cramping which the family doctor told me was because of the IUD. Then I saw my OBGYN who said it was because I had an enlarged fatty liver and needed to seek more medical help. It often was random sharp pains in the uterus area then reaaallly sharp pains on the upper right quadrant and by the time I saw my family doctor (after the testing) the pain extended to my upper left quadrant. (close to my rib cages) My family doctor then told me that it didn't matter and just eat better and exercise more. This was last investigated in November. Leg pain - Shortly after this visit, I had to stop because my shins were killing me (couldn't even walk on them) and the doctor poked them lightly then said they were shin splints and to rest. I limited my activity to 30 minutes of brisk walking but even that got too excessive so I stopped entirely. Now, even just sitting down I feel my legs spasm - primarily in the shins and slightly above the knees - my left more than my right. If I'm walking, I feel sharp pains completely randomly start from my left buttock all the way down to my toes. I've been having those walking pains since my first child but they come and go. I saw a chiropractor who said he thought I might've had herniated discs that were pressing on nerves but needed to do more testing after my pregnancy to verify, but hasn't verified since. My shin problem occurred in October. Prior to the shin problem, I was exercising intensely from April to October doing 2 hours a day, 5 days a week and had lost 35 lbs. Due to the shin issue, I had to stop my exercise. Vaginal issues- in addition to my leg spasms, I often feel numbness in the upper-inner thigh on my left side which also results in me having the left side of my vagina numb. Feels like your foot would feel like if it fell asleep. Even if I touch it, I mentally know it's being touched but can't feel it. I do have genital herpes but it is HSV-1 and I rarely have outbreaks. Continually, I have noticed there is one spot on the left side that keeps getting recurring acne.. just one giant white head that looks like it's ontop of a blister but feels like a pimple... and if I pop it it comes back a few times before goes away. This has happened three times since early January. Feet - Both my right and my left feet go randomly numb - more so my left. Even if I'm just walking or sitting for dinner... it will randomly go numb and fall asleep. Nausea - not enough to throw up but enough to lose appetite. I have to consciously eat 3 meals a day otherwise I forget because my stomach is just so upside down feeling. Heartburn - I was told as a young teen I had gastro esophageal reflux disease, was on medicine for it, but then changed my diet to avoid foods that triggered it and since then rarely have problems. I haven't had a diet change since then but since the pregnancy, it got better for a few months but has been back full force for about 4-5 months now. Hand problems - I've been having sharp pains in my wrists and occasionally losing grip while I'm holding stuff - primarily with my right hand. Extra fatigue - No matter if I sleep 2 hours or 12 hours I feel the exact same tiredness. I've tried making my sleep schedule the same, which didn't solve the issue. I've tried increasing my fruits and vegetables, my vitamin C, eating more foods with natural energy, but all of which don't work. I've tried changing the layout of my room, which didn't help. I can literally sleep any where any time if I was given the opportunity. Chest problems - my chest has occasional sharp pains since October. When I talked to my family doctor about it he said I was 23 (at the time) and just need to exercise more. He commented on my weight as I was 175lbs and 5'4" (even though I wasn't eating much at all and exercising often) and said I needed to exercise more. I told him I would try but didn't think that was the problem... Since then, I've stopped exercising but still get my daily walks in and am constantly on the go. Even walking up a flight of stairs sends me out of breath and I feel like someone is constantly sitting on my chest. About 3-5 times a day I get the sudden, sharp pains but then it subsides to just the heavy, tightness on my chest. I'm not gasping for air but I feel it significantly harder than the summertime when I was exercising so much more. Excessive Thirst - I have been ridiculously thirsty. When mentioned to my doctor he said that it was okay. Over an 8 hour shift I drink 8-10 glasses of water and maybe 4 1L water bottles throughout the day. If I don't drink much water, I feel like I'm going to faint. Even with all my water consumption, my mouth feels dry and pasty. Lungs - I was born with underdeveloped lungs. My mother smoked around me as a child and I have chronic bronchitis. I didn't get it for a couple of years but I feel like it's back again. :( On Feb 4th, - I donated blood for the first time. (I'm O-). And within 5 minutes of the donation they had to stop because my arms got randomly cold and I nearly fainted. After this donation, I have had the chest problems restart and now have been constant. I had random times when my heart would start racing for no reason. My hemoglobin count was 153 at that point. I am tired of being in pain 24/7 and I miss my exercise. I am now 185lbs and have noticeable weight gain. I feel like I can't move without pain and discomfort. I really hope you have some suggestions because my doctor seems to think I'm 100% okay and everything feels like it's getting worse. I just want to curl into a ball and stay in bed all day. I hope you can help! One other thing I forgot to mention... starting in September, whenever I would run, I would feel sharp pains in my shoulder blades as well as if it was piercing with a knife and made it very difficult to breathe. Advice?
Posted Thu, 13 Mar 2014 in Women's Health
Answered by Dr. Rakesh Karanwal 2 hours later
Brief Answer: Tests required to confirm the given possibilities Detailed Answer: Hi Young Lady, Thanks for your query. You have several problems, which may- or may not- be interrelated. Your problems point towards the following possibilities:- 1. Severe bleeding during childbirth can result in tissue death in the pituitary gland. This causes the gland to lose its ability to work properly. The condition is called Sheehan Syndrome (which can account for features of under-active thyroid, fainting attacks, generalized weakness, lethargy, fatty liver and some of the other symptoms. 2. Pregnancy-related conditions, such as, affection of the heart (called Post-Partum Cardiomyopathy) which can account for progressive breathlessness on exertion, chest pains and palpitation). 3. Gestational diabetes :- a latent predisposition to develop diabetes, which gets unmasked during pregnancy. 4. Multi-vitamins and Minerals deficiency:- - Calcium and Vitamin D deficiency which commonly occurs following pregnancy, and which can account for bony pains. 1250mg of Calcium + Vitamin D3 (Calcitriol) daily will give you gradually progressive relief. - Vitamin B12 (Methylcobalamin) deficiency (causing numbness, tingling in the lower limbs. Take Vitamin B12 1500 micrograms/day. 5. Lastly, the problems in the lower limbs may be due to nerves compression or Vitamin B12 deficiency. MRI of the lower spine needs to be carried out to detect/rule out compression over the nerves supplying the lower limbs. Or, it may a long-term complication of subdural anesthesia- if given to you- to reduce labor pains. In a nutshell, you need to undergo the following investigations:- * MRI Brain to detect partial destruction of Pituitary gland. * MRI of Lower spine * ECG and 2-D Echo to detect/rule out Post-partum Cardiomyopathy * Thyroid hormone levels, cortisol levels, female hormone levels - to confirm the diagnosis of improperly functioning Pituitary gland. * Blood sugar test for detecting diabetes, if present. * Blood Vitamin D and Vitamin B12 levels to detect deficiency. Consult your doctor and apprise him of my opinion. I am certain that he will agree with me; order required tests, and- based on the reports- will arrive at a certain diagnosis and prescribe suitable treatment as advised. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Take care and May God Bless You, Col (Dr.) Rakesh Karanwal
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