Endocrine Abstracts

Background: Sheehan’s syndrome occurs after a delivery complicated with hemorrhage causing ischemic pituitary necrosis and panhypopituitarism. It is rare for a patient with Sheehan’s syndrome to obtain recovery of the pituitary function. We report the case of a patient with Sheehan’s syndrome who obtained a spontaneous pregnancy 2 years after the initial diagnosis.

Case presentation: A 23-year-old-woman, without a significant personal medical history, gave birth, uneventfully, to a healthy boy in 2015. After delivery, she failed to lactate and remained amenorrheic. Seven months later, she consulted in another endocrinology service for persistent amenorrhea, weight gain, extreme fatigue and sleepiness. The hormonal dosages revealed panhypopituitarism and the magnetic resonance imaging (MRI) detected a pituitary hypotrophy, all consistent with Sheehan syndrome. A substitutive treatment was prescribed with Prednisone 2.5 mg/day, Thyroxin 50 μg/day and oral cyclic estrogen/progesterone combination (COC). After 2 years, by her own initiative, the patient stopped taking COC, became pregnant spontaneously and gave birth uneventfully to a healthy girl. Post-partum, she still failed to lactate but menstrual cycles restored. In 2019, hormonal dosages showed recovery of the thyrotropic, somatotropic and gonadotropic functions, but persistence of the corticotroph and lactotroph failure and persistent pituitary atrophy in MRI. The replacement therapy with Prednisone 5 mg/day was continued.

Conclusions: This case illustrates the possible occurrence of Sheehan syndrome even in women with normal delivery and, in time, the possible partial recovery of the pituitary function, pointing out the necessity of long-time monitoring of these patients.