Endocrine Abstracts

Introduction: Sheehan syndrome (SS), or postpartum pituitary necrosis, is a rare but potentially serious complication of postpartum. we describe a patient whose diagnosis of sheehan’s syndrome was delayed and revealed by a cardiovascular collapse.

Case report: A 36 year old femele patient, admitted to the intensive care unit in a state of septic shock due to pyelonephritis, was intubated, ventilated and put on noradrenaline in SAP and antibiotic therapy, in view of the non-improvement and low blood pressure figures despite the filling and vasoactive drugs, as well as hypoglycemia with a hyponatremia of 110 and hyperkalemia of 6 on the ionogram, acute adrenal insufficiency was suspected and the 8-hour cortisol level confirmed the diagnosis (0.8 mg/dl), patient put on intravenous hydrocortisone hemisuccinate. The evolution was marked by an improvement, patient extubated and weaned from vasoactive drugs, the interrogation revealed an antecedent hemorrhagic childbirth with absence of milking and absence of return of childbirth, and the patient kept an important asthenia in postpartum but and consulted each time for a digestive picture made of abdominal pains and nausea put under symptomatic treatment without the diagnosis of adrenal insufficiency being suspected. The patient was then admitted to the endocrinology department for further management with evidence of a gonadotropic, corticotropic and thyrotropic deficit, the somatotropic axis was not explored, the pituitary MRI was without anomalies.

Discussion: This observation is typical of Sheehan’s syndrome, both in its clinical presentation and in the diagnostic errors that it can cause.

Conclusion: Postpartum pituitary necrosis is a difficult diagnosis in the acute phase and is often overlooked. This diagnosis should be evoked in any patient who has had a collapse during childbirth, whatever its cause, in front of the appearance of early headaches or a meningeal syndrome, and/or in front of the later appearance of the classic signs of pituitary insufficiency (absence of lactation, weight loss, asthenia, arterial hypotension, secondary amenorrhea)