Endocrine Abstracts

Introduction: Hyponatremia occurs in 33–69% of women with postpartum pituitary necrosis. The aim of the study was to present a patient in whom recurrent hyponatremia was one of the dominant symptoms of postpartum anterior pituitary hormones deficiency.

A case report: 55-year-old woman with a diagnosis of Sheehan syndrome established 19 years after the last labor complicated by massive bleeding due to uterine atonia. The first symptoms of pituitary insufficiency were the lack of lactation and secondary amenorrhea. In addition, the patient complained of weakness, fatigue, psychomotor retardation, depressed mood, dizziness, hypotension including orthostatic hypotension, flushing, loss of appetite, abdominal pain, recurrent episodes of nausea and vomiting, weight loss. She observed dry skin, loss of pubic and axillary hair, loss of eyelashes and eyebrows and recurrent infections of the urogenital system. Over the last few years she was hospitalised for recurrent hyponatremia (Na 115–125 mmol/l) many times. The hormonal measurements were: ACTH=32.5 pg/ml; cortisol circadian rhythm=2.6–1.3 μg/dl; daily urine cortisol excretion=6 μg/day; DHEAS <3.0 μg/dl (normal range: 25.9–460.2); PRL=3.5 ng/ml; LH=1.5 mIU/ml; FSH=5.03 mIU/ml; estradiol <12.0 pg/ml; GH <0.1 ng/ml; IGF-1=10 μg/l (normal range: 50–184); fT₄=6.6 pmol/l; fT₃=1.1 pmol/l; TSH=2.36 mIU/l. Ultrasound examination showed the 8.5 ml thyroid gland with normal echogenicity. MRI revealed partial empty sella syndrome with small (7×3 mm), symmetric pituitary with normal morphology of the signal.

Conclusion: Recurrent hyponatremia may be one of the dominant symptoms in the patient with long-lasting and unrecognised pituitary insufficiency after a pathological labour.