Endocrine Abstracts

Introduction: Sheehan’s syndrome (SS) is a cause of partial or total hypopituitarism that occurs after postpartum pituitary infarction, in the context of serious bleeding and/or hypotension. With the advancement of obstetric care, it has become a rare disease in developed countries, but its prevalence may be underestimated. Clinical presentation is dependent on the severity of hormonal deficits, is often nonspecific and many women may be asymptomatic for years. These reasons contribute to a delay in diagnosis and in treatment of a significant cause of morbidity and mortality in affected women.

Clinical case: We report a case of a 32 years old woman sent to endocrinology consultation because of hypogonadotropic hypogonadism. Past history: menarche at 11 years with regular cycles, two pregnancies, a normal delivery without complications (17 years) and a miscarriage at 8 weeks gestation (28 years). After the miscarriage, she was hospitalised with anaemia and needed blood transfusions. She’s amenorrhoeic since the miscarriage. Currently, she’s asymptomatic and desires another pregnancy. On physical examination, highlight for a low BMI (17 kg/m²). Analytically, FSH 1.08 mUI/ml (2.5–10.2), LH<0.07 mUI/ml (1.9–12.5), oestradiol 63.89 pmol/l (71.6–529.2), TSH 1.43 μUI/ml (0.358–3.74), FT₄ 0.75 ng/dl (0.76–1.46), prolactin 4.67 ng/ml (2.8–29.2), cortisol 13.6 μg/dl (4.3–22.4), ACTH 19.7 pg/ml (<46), somatomedin 110 ng/ml (115–307), testosterone <10 ng/dl (14–76), normal DHEAS and androstenedione. Insulin induced hypoglycaemia reveals normal response of cortisol and GH. Pituitary MRI revealed a concave gland with lower dimensions than expected for her age. She was treated with levothyroxine 50 μg/day and oriented to assisted reproductive consultation.

Discussion: The patient presented corresponds to a case of hypopituitarism due to probable pituitary infarction after abortion. We emphasise the importance of the evaluation of pituitary function in women with childbirth history associated with significant blood loss, even several years after the episode.