Endocrine Abstracts

Introduction: Sheehan’s syndrome (SS) is the development of partial or complete hypopituitarism following parturition, preceded in most of the cases by severe postpartum hemorrhage. The disease continues to be common in some developing countries.Some of the anterior pituitary functions like gonadotrophic and corticotrophic secretions may be preserved in these women. The purpose of this observation is to reporte a rare case of spontaneous pregnancy occurs in a patient followed for Sheehan’s syndrome, as well as to indicate the principles of management.

Case: H.T. a 38-year-old woman, delivered her first child in 2007 with a delivery bleeding. She didn’t had lactation failure and did resume menstrual cycles. She had a cesarean delivery in her second pregnancy in 2010, it was complicated by bleeding as well and was transfused, and was hospitalised 10 days in intensive care. The Investigations revealed central hypothyroidism and cortisol deficiency. She was put on hydrocortisone and Levothyroxin. She had also developped spaniomenorrhea. Five years laters, the patient was prangnant and was reffered to us for the follow-up, whitch was based on clinical and biological monitoring of substitutions associated with obstetrical monitoring. The birth took place without incident. The MRI had objectified an empty sellar.

Discussion: Spontaneous pregnancy rarely occurs while Sheehan’s syndrom. Hypopituitarism during pregnancy should be followed strictly, and normal hormone levels should be achieved before any pregnancy. In our case, after the confirmation of Sheehan’s syndrome, menstrual cycles remained irregular, the patient was not taking contraception, although she did not want a child. The patient received informations about the safety of her pregnancy if followed- up regularly. Indeed, it has been reported that inadequate hormone replacement in pregnant women with Sheehan’s syndrome cause miscarriage in 50% cases and 27% of maternal mortality.

Conclusion: Because of hypopituitarism signs are non specific, the diagnosis of Sheehan syndrome should be considered, in any patient with postpartum hemorrhage history. In patients with preserved gonadal function, contraceptive use should be recommended.