Endocrine Abstracts

Introduction: Sheehan’s syndrome is a rare postpartum complication. Recurrent hypoglycaemia,though described is a rare complication of Sheehan syndrome. Here we report a case of Sheehan syndrome which presented with hypoglycemic coma.

Case Presentation: We report the case of a 47-year-old woman who presented to the medical emergency unit with coma. There was no history of chest pain, fever, headache, vomiting, trauma, or seizures. She had no history of chronic illness or addictions. She delivered her last baby at home 18 years old back when she was gravida 5, parity 3 during which severe PPH occurred, for which she was hospitalized, and 2 units of packed cells were transfused. She did not breast feed the baby. On examination, she was inconscious, cool, and clammy. The systolic blood pressure was 50 mmHg, pulse rate was 60 beats/min regular, temperature was 37 by axilla, and blood sugar was 25 mg/dL. She regained consciousness after bolus intravenous infusion of dextrose solution. There was dryness of skin, conjunctival pallor, facial puffiness, delayed ankle jerk, and slowness of speech. Pubic and axillary hairs were scanty. Hematology revealed pancytopenia, with the diagnosis of iron deficiency anemia. Hypothalamic-pituitary MRI showed arachnoidocele and hormonal evaluation revealed adenohypophyseal insufficiency as evident from decreased levels of cortisol, thyroid-stimulating hormone, triiodothyronine, free thyroxine, follicle-stimulating hormone, luteinising hormone and prolactin. Based on clinical, radiological and laboratory parameters her final diagnosis was Sheehan syndrome with hypoglycaemia.

Discussion: Presentation of Sheehan syndrome can be acute or chronic; acute presentation being even rarer. The diagnosis of Sheehan syndrome is often delayed by many years, may be up to 15–20 years, because other signs of adenohypophyseal insufficiency are often delayed and subtle. Hypoglycaemia is a rare presentation of this syndrome in acute and delayed cases. In our case, diagnosis was made 18 years after the last obstetric event The delay in making diagnosis was 16.3±4.7 years in a series of 20 cases of Sheehan syndrome 2.

Conclusion: Hypopituitarism should be kept in differential diagnosis while working up a case of severe or recurrent hypoglycaemia 2.

Bibliography: 1. HK Aggarwal and al,Recurrent Hypoglycaemia: an Uncommon Presentation in Sheehan Syndrome. Eur J Gen Med 2016;13(2):155–157.

2. Naresh kumar and al:Recurrent hypoglycaemia: a delayed presentation of Sheehan syndrome. BMJ Case Rep. 2014.