Endocrine Abstracts

Introduction: Pituitary insufficiency of the adult is a rare pathology (~30–40/1 000 000 per year). Among the acquired causes, Sheehan syndrome (SS) is often characterized by an insidious evolution, which allows it to pass unnoticed for a long time.

Case report: R Maria, 58 years-old, known with SS for 10 years, was hospitalized in the ER with severe asthenia, obnubilation, symptomatic arterial hypotension. Laboratory studies revealed severe hyponatremia (115 mmol/l) and important cytolysis (CK=21 520 U/l, CKMB=326 U/l, LDH=731 U/l) with normal ECG. A myocardial or skeletal muscle etiology was excluded. After successful intensive care she was transferred to Endocrinology. Anamnesis revealed cessation of corticotherapy and intermittent thyroid substitution. Physical examination showed bradylalia, generalized myalgia, pale, infiltrated, depigmented, depilated skin. Biology confirmed pituitary insufficiency: low FT₄=3.72 pmol/l, paradoxically normal TSH=2.15 mUI/ml, low ACTH=15.5 pg/ml, low LH=0.4 mUI/ml despite the menopausal status. Under substitution therapy (glucocorticoides and L-thyroxin) and hydroelectrolytic equilibration, patient’s general status improved progressively, as well as the biological parameters (Na=137 mmol/l, FT₄=8.17 pmol/l, CK=129 U/l, CKMB=10 U/l, LDH=370 U/l).

Conclusions: Due to the rarity of both the SS and its therapeutic non-compliance, few studies have evaluated its evolution. High enzymes are found in 1/3 of the cases of hypothyroidism, but the values are rarely significant. Due to normal TSH (as in our case), secondary hypothyroidism can be ignored in the differential diagnosis. Our case is particular because of the severe hypothyroidism manifestations, despite the coexistence of the pituitary corticotrope insufficiency.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.