Endocrine Abstracts

Introduction: Sheehan syndrome (SS) is a potentially serious complication of the postpartum period, corresponding to ischemic necrosis of the anterior pituitary gland in connection with delivery hemorrhage, and remains a topical issue despite improvements in gyneco-obstetrical management. The objective of our study is to investigate the epidemiological, diagnostic and therapeutic aspects of sheehan’s syndrome for better management.

Patients and methods: Retrospective study carried out at the Endocrinology and Metabolic Diseases Department, Ibn Rochd University Hospital - Casablanca, on patients hospitalized from January 2000 to December 2023 for partial or complete antehypophyseal insufficiency on sheehan syndrome.

Results: In our study, 38 patients were included. The average age of the patients was 55 years. The etiological factor was delivery hemorrhage, requiring hemostasis hysterectomy in 6 patients. The time to diagnosis was 20 years (40 days - 40 years). Clinical symptomatology was dominated by the absence of lactation, amenorrhea, axillary or pubic depilation and signs of hypothyroidism. The hormonal assessment including an assay of the cortisolemia of 08h, FSH, LH and TSH was carried out in all our patients, showing a complete deficit of the 3 hormonal axes. Hypohyseal MRI was performed in 18 patients, showing an empty sella turcica in 16 and pituitary apoplexy in 2. Complications in our patients included diffuse bone demineralization in 20 cases and 8 cases of depression. all our patients received hormone replacement therapy with hydrocortisone 20 to 30 mg/d and L-thyroxine 50 to 100 mg/d. 11 patients were put on oestroprogestins, with a good evolution.

Conclusion: Sheehan’s syndrome is usually diagnosed late. It should be considered in the case of absence of lactation with amenorrhea after a hemorrhagic delivery, and in the case of chronic asthenia in a woman with a gyneco-obstetrical history.