Endocrine Abstracts

Sheehan is an Interesting disease; post-partum bleeding can cause dangerous pituitary gland necrosis. Sheehan’s syndrome is a well-known condition that is generally diagnosed several years postpartum or can present acutely. Hypopituitarism after diagnosis of Sheehan syndrome can be present in insidious ways and there may be delay to diagnosis of over a decade because symptoms are often vague and pituitary dysfunction progresses gradually. We presented the case of hypopituitarism after a decade of diagnosis of Sheehan syndrome.

Case Presentation: A 75 year- old woman, presented to the clinic for feeling tiredness and lethargy in 1994. She was diagnosed with Sheehan syndrome in 1945 after post-partum haemorrhage with shock and inverted uterus. She was subsequently found to have growth hormone, cortisol deficiency as well as central hypothyroidism in 1994 and on hormonal replacement therapy. She was also treated for hyperlipidaemia with rosuvastatin and fenofibrate. Furthermore, Raloxifene 60 mg daily was given for 4 years to prevent from the effect of the steroid therapy and stopped after satisfactory DEXA scan.

Conclusion: Sheehan syndrome is a rare condition of progressive pituitary dysfunction, which can present with nonspecific symptoms and a myriad of laboratory abnormalities until an adrenal crisis is triggered years after the precipitating event. Screening patients for hypopituitarism by free thyroxine levels and adrenocorticotropic hormone (ACTH) stimulation testing is vital for determining whether hypopituitarism is the cause in the appropriate clinical scenario. Use of thyroid-stimulating hormone levels and morning cortisol testing alone will miss this diagnosis, and free thyroxine levels and ACTH stimulation testing are vital.