Which drug is essential in Sheehan's syndrome-

Sheehan syndrome, is a rare complication of postpaum hemorrhage, where there is necrosis of the pituitary gland (anterior pituitary is more susceptible to damage than the posterior pituitary) and pituitary failure. The pituitary gland is physiologically enlarged in pregnancy and is therefore very sensitive to the decreased blood flow caused by massive hemorrhage and hypovolemic shock. The typical picture is failure of lactation (first sign often), amenorrhoea, hypothyroidism and adrenocoical insufficiency. Treatment of young women with Sheehan's syndrome usually includes replacement of hydrocoisone first and then replacement of thyroid hormone and estrogen with or without progesterone depending on whether she has a uterus. Hydrocoisone is replaced first because thyroxine therapy can exacerbate glucocoicoid deficiency and theoretically induce an adrenal crisis. The standard dose of hydrocoisone is 20 mg/d for an adult (15 mg every morning and 5 mg every evening). Reference : page 402 Textbook of Obstetrics Sheila Balakrishnan 2nd edition