Endocrine Abstracts

Introduction: Sheehan’s syndrome presents with hypopituitarism of variable severity after parturition usually preceded by post partum hemorrhage. Recovery of lactotroph function after initial insult has not been reported in the literature.

Case report: A 41-year woman delivered her 1st child in 1994 at the age of 25 years, complicated by profuse vaginal bleeding and received two blood transfusions at a city hospital. She had lactation failure and did not resume menstrual cycles after. She was investigated in 1996, revealing central hypothyroidism, GH, prolactin and cortisol deficiency on insulin tolerance test. She was put on prednisolone 7.5 mg/day, thyroxine 0.75 mg/day and cyclic estrogen/progesterone. She came to the hospital with pregnancy of 12 weeks duration and delivered in Dec 2003. After the present delivery, she lactated normally. She resumed infrequent cycles after the lactation amenorrhea. In 2007 incidentally she was again found to have pregnancy of 20 weeks on a routine ultrasound, she delivered after a cesarean section and again lactated normally. Metochlopramide test revealed normal stimulable prolactin. MRI pituitary revealed empty sella.

Conclusion: Recovery of lactotroph function after initial failure has not been reported in patients with Sheehan’s syndrome. We presume that recovery of lactotroph function after the second pregnancy in this patient is possibly because of stimulatory effect of estrogen and progesterone on residual lactotroph cells.

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.

Figure 1 MRI pituitary sagital view showing pituitary fossa filled with cerebrospinal fluid and stalk touching the base of pituitary floor; features suggestive of empty sella.

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