Endocrine Abstracts

Introduction: The enlarged pituitary gland of pregnancy is susceptible to any compromise to its blood supply. Sheehan’s syndrome (SS) occurs as a result of post-partum pituitary infarction or haemorrhage and usually leads to hypopituitarism. It can be fatal but clinical manifestations may change from one patient to another and symptoms may not occur for many years.

Methods: We analysed retrospectively five cases of women with SS aged 26–56 years, treated at Endocrinology Department between 2003 and 2014, to describe clinical manifestations. In the studied subjects the diagnosis of SS was made based on medical history, clinical symptoms, hormonal tests, and MRI scans.

Results: Mean age of the patients was 41.00±12.33 years (range 26–56 years). All subjects had typical physical signs of SS. The duration between date of the last delivery and time of diagnosis was 9.82±8.85 years (ranged from 1 month to 19 years). The number of pregnancies was from 1 to 4. We observed typical obstetric history of massive hemorrhage at delivery in three women, two of them received a blood transfusion. In two cases there was no overt obstetric complications. All patients lacked post-partum milk production and did not menstruate following delivery. According to the hormonal values, five analyzed women had total or partial secondary hypothyroidism, adrenal cortex failure and hypogonadotropic hypogonadism, prolactin, and GH deficiency. They used therapy such as: hydrocortisone (mean 25.00±7.07 mg/day), levothyroxine (mean 75.00±43.30 μg/day), and sex hormone replacement. Diabetes insipidus was found in one patient but it was transient. She was treated with desmopressin (120 μg/day) for 17 months. MRI scans revealed total or partially empty sella in three women and small (beyond the normal range) pituitary gland in two cases.

Conclusion: Although, SS is not a common disease, it should be remembered about concerning women with pituitary insufficiency developing at different times after delivery.