Endocrine Abstracts

Introduction: Sheehan’s syndrome is a rare cause of hypopituitarism secondary to an intra or postpartum severe bleeding. Manifestations are most often caused by deficiencies of hormones of anterior pituitary; involvement of posterior pituitary is rarely described.

Case report: We report a case of a 45 years old hypertensive, multipara, premenopausal woman, who underwent fertilization by oocyte donation, that resulted in twin pregnancy. Preterm vaginal delivery was complicated with severe post partum hemorrhage and shock due to surgical placental fragments removal. Agalactia and a persistent polyuric–polydipsic syndrome, with daily diuresis >5 l, developed on the immediate post partum. MRI showed ectopic neurohypophysis; serum osmolality 288 mosm/kg; urinary osmolality 89 mosm/kg. After intranasal desmopressin urinary osmolality raised to 372 mosm/kg and diuresis normalysed. Four months after delivery, she was still amenorrheic and presented asthenia and swelling. Multiple hypothalamic–pituitary axis evaluation resulted ACTH, TSH, FSH, LH, PRL and GH deficiencies. Started treatment on prednisone and levothyroxine with clinical status improvement. At 6 months of follow-up she is asymptomatic and the MRI showed normal pituitary.

Conclusion: Central diabetes insipidus is rare in Sheehan’s syndrome; in this patient it was the primary manifestation. The rapid onset of the anterior pituitary hormones deficiency is also not frequent.