Endocrine Abstracts

Introduction: Dabigatran is a direct thrombin inhibitor which is used for reducing the risk of stroke or systemic embolism in patients with atrial fibrillation. Although INR monitoring is not required in the course of treatment, it may be complicated with spontaneous systemic bleeding. Sheehan’s syndrome is characterized with panhypopituitarism which is caused by necrosis of the pituitary gland. Recent studies have demonstrated that panhypopituitarism is associated with bleeding disorder.

In the current study, we report a case with panhypopituitarism who suffered from gastrointestinal bleeding while using dabigatran.

Case report: A 74-year-old female patient admitted to the emergency department with the complaint of weakness and melena for the last 3 days. The physical examination revealed hypotension and tachycardia. The patient has been treated with dabigatran for paroxysmal atrial fibrillation for the last 1 month. She had no history of previous bleeding and antiplatelet treatment.

The laboratory test results were consistent with severe anemia (Hb: 3.8 g/dl), elongation of prothrombin time (15.1 s) and INR (1.37). Upper gastrointestinal endoscopy revealed multiply erosions in antrum. The patient developed profound hyponatremia (Na: 119 mEq/l) and progressive lethargy on the third day of follow-up. The advanced examination showed adrenal insufficency and central hypothyroidism.

Discussion: The Sheean syndrome has a very large spectrum of clinical presentation ranging from non-specific symptoms to coma. It may also lead to bleeding tendency rarely. Clinicians should consider this rare complication especially in patients who are to be treated with dabigatran.