[Sheehan's syndrome in sudano-sahelian Africa. 40 observations]

Postpartum hypopituitarism or Sheehan's syndrome is frequent in Sahelian Africa. From February 1983 to July 1988, the authors observed 40 cases at National hospital of Niamey (Republic of Niger). These patients were Black African women living in rural areas, without medical assistance during the last delivery. Two signs were required for the diagnosis: absence of postpartum lactation and prolonged amenorrhoea. A 15 points score was used for identification of each case. Postpartum hypopituitarism is a severe disease in Sahelian Africa: after the pituitary necrosis, 80% children died. 60% of patients had no living child or only one malnourished infant with a poor prognosis. The social future of these sterile African women seemed uncertain. Hormonal treatment (estrogens, thyroxin, cortisone) is justified but expensive. Exceptionally a pregnancy developed after Sheehan's syndrome under treatment with childbirth of a living infant.