Endocrine Abstracts

Background: Sheehan’s syndrome (SS) is rarely encountered in developed countries due to advanced obstetric care but it is still frequent and a major threat to women in developing nations. Anaemia among other risk factors may increase the risk of Sheehan’s syndrome.

Case report: 36 year old woman, known sickle cell disease (SCD) patient with previous history of stroke in childhood, presented to the heamatologists on account of generalized body weakness and body pain of 3 weeks duration. While on admission, she was noticed to be having recurrent hypoglycemia. She had history of postpartum hemorrhage 7 years prior to presentation. Since then; there was history of failure to lactate, amenorrhea. She developed cold intolerance, slowness and hair loss few months afterwards. Admitting blood glucose was 10 mg/dl and blood pressure was 80/60 mmHg. She had hyponatremia (Na 128.1 mmol/l), 0800 h cortisol – 89.11 mmol/l(240–618), FSH – 5.72 IU/l, Prolactin – 1.22 ng/ml (3.3–26.7), TSH 1.703 mIU/l(0.380–5.330), FT4 0.129 pmol/l (7.2–16.4), FT3 0.001 pmol/l (3.8–6.0). Growth Hormone was <0.05 ng/ml. Cranial MRI and other hormonal profiles could not be done due to gross financial constraint. She was commenced on Intravenous fluid 5% Dextrose saline, IV hydrocortisone 100 mg 6 hourly, Levothyroxine 62.5 mcg dly. She was discharged home when stable on Tab Prednisolone 40 mg dly, Tab Levothyroxine 125 mcg on alternate days and has attended 2 outpatients follow up visits afterwards.

Discussion: Vessel occlusion and ischemia associated with SCD increases the risk of developing SS in addition to massive heamorrhage occuring during or after delivery leading to necrosis of the pituitary gland.

Conclusion: Sheehan’s syndrome can be life threatening if not recognised. Early diagnosis and treatment with lifelong hormone replacement is important to reduce associated morbidity and mortality.

Keywords: Sheehan’s syndrome, hypopituitarism, lactation failure, postpartum heamorrhage.