Endocrine Abstracts

We describe a case of 31 year young lady with Type 1 Diabetes, who started experiencing reduction in insulin requirement and hypoglycaemia episodes due to an endocrine disorder following Pregnancy. She presented with recurrent episodes of documented hypoglycaemia and amenorrhea following successful pregnancy. Her basal insulin requirements fell from 36 units to 24 units per day and she required little if any insulin as bolus (0.5 unit for every 10 gm). She did not breast feed. She denied any headaches and visual symptoms. Further questioning revealed a difficult labour with forceps delivery and intrapartum haemorrhage needing blood transfusion. She was clinically hypothyroid with slow relaxing ankle jerks. Her Blood pressure lying and standing was 123/88 mm hg and 135/84 and weight 81.45 kg. She was not pigmented and had no features of Addison’s disease. Her Visual fields were normal and had no other signs of endocrinopathies. Further investigations showed abnormal pituitary function as evidenced by TSH 0.92 mu/L, Ft4 <3.0 pmol/lit, 10 am cortisol 173 nmol/l, GH <0.05 ug/L, IGF-1 <3.2 nmol/l, FSH 4.6 iu/l, LH 2.9 iu/L, oestradiol 35 pmol/l. Short synacthen test showed baseline cortisol of 71 nmol/l, 30 min 233 nmol/l. MRI showed empty sella confirming likely diagnosis of sheehans syndrome. She was commenced on levothyroxine and hydrocortisone. We will explore growth hormone and fertility issues in future.

Conclusion: We would like to take this opportunity to discuss and remind ourselves Sheehans syndrome a possible reason for diminishing insulin requirements in postpartum patients with Type 1 Diabetes. Is it vanishingly rare.