Endocrine Abstracts

Introduction: Postpartum infarction of the anterior pituitary, known as Sheehan’s syndrome, is a rare cause of hypopituitarism. In many cases, the hormones deficiency is sequential which implies late diagnoses.

Case Report 1: A 51-year-old woman was observed because her mother had medullary thyroid carcinoma. She had no evidence of endocrine neoplasia. Nevertheless, she was experiencing fatigue, hair loss and dry skin for several months. Her history included a postpartum haemorrhage at 22 with blood transfusion requirement. She was unable to breastfeed and mentioned oligomenorrheic cycles after that and took two years to get pregnant again. Menopause was at 43. Physical examination was unrevealing. Baseline endocrine evaluation revealed low gonadotrophines, IGF-1 and fT4 with inappropriate normal tyrotrophin, PRL of 2.5 ng/ml and morning cortisol of 8.7 mcg/dl with ACTH of 15.3 pg/ml. A multiple pituitary stimulation test confirmed the deficiency of all anterior pituitary hormones except the pituitary-adrenal axis. Levothyroxine reposition was prescribed.

Case report 2: A 78-years-old woman was referred to the endocrinology outpatient department after hospital admission due to hypotension, hyponatremia (113 mmol/l) and rhabdomyolysis that improved with corticotherapy. She reported asthenia, weakness, myalgias and anorexia that worsened progressively 2 years before admission. Her third pregnancy occurred at the age of 28, with severe blood loss at delivery, inability to breastfeed, oligomenorrheic cycles after that and menopause at 36. Endocrine evaluation confirmed a panhypopituitarism and the CT scan showed an empty sella turcica. She became asymptomatic with hydrocortisone and levothyroxine reposition.

Conclusion: These cases represent two very late diagnosis of Sheehan’s syndrome. Appropriate obstetric/gynaecologic history and clinical suspicion are required to avoid late manifestations of the disease, namely an adrenal crisis, because the pituitary-adrenal axis is usually the last one failing. Timely treatment may dramatically improve quality of life of these patients, who may experience hypopituitarism for long years before diagnosis.