produced directly, or indirectly, by the pituitary gland. The extent of hormone deficiency, and which hormones are affected depends on the extent of the damage to the pituitary. Hormonal assays measure the levels of these hormones which include but are not limited to T4, TSH, estrogen, gonadotropin, cortisol, and ACTH. It might be difficult to detect damage to these hormone pathways if hormone levels are at the borderline of the abnormal range. In this case, stimulation tests will be done to determine if the pituitary is responsive to hypothalamic hormones. MRI is useful in diagnosing Sheehan's syndrome since it examines the structure of the pituitary and may identify any anatomical damage. MRI findings will vary based on how early or late in the disease process the test is being conducted. If an MRI is conducted early enough in the disease process the pituitary may appear larger than normal, and show changes that are consistent with damage from lack of blood supply. Later in the disease process of this syndrome the damage imposed on the pituitary gland will cause it to shrink, and leave a partially empty or totally empty sella turcica on MRI. Treatment The mainstay of treatment is hormone replacement therapy for the hormones that are missing. Treatment plans and dosages should be individualized by an endocrinologist. Glucocorticoids may be administered to address or prevent an adrenal crisis, a potential serious complication of Sheehan syndrome. Hormone replacement is vital in reducing the morbidity and mortality of this syndrome. Epidemiology The exact prevalence of this syndrome is difficult to define because the incidence varies so much from country to country. Sheehan syndrome is more prevalent in developing countries than developed countries. In a study from the United Kingdom in 2001 only 1.4% of patients with hypopituitarism were diagnosed with Sheehan's syndrome. Just a few years earlier in 1996 the World Health Organization estimated that 3 million women were effected by Sheehan's syndrome. In a study of 1,034 symptomatic adults, Sheehan’s syndrome was found to be the sixth-most frequent etiology of growth hormone deficiency, being responsible for 3.1% of cases (versus 53.9% due to a pituitary tumor). Additionally, it was found that the majority of women who experienced Sheehan syndrome gave birth at home rather than in a hospital. History The specific association with postpartum shock or hemorrhage was described in 1937 by the British pathologist Harold Leeming Sheehan (1900–1988). The