Endocrine Abstracts

Introduction: Sheehan’s syndrome (SS) results from severe post-partum hemorrhage leading to necrosis of the pituitary gland. Here we describe the clinical characteristics of patients with Sheehan syndrome.

Methods: We conducted a 44-year cohort study (1977 to 2021) of patients with SS followed at the endocrinology department of Farhat Hached Hospital in Sousse, Tunisia. Medical history, physical examination findings and laboratory investigations were documented.

Results: One hundred and twenty-three patients diagnosed with Sheehan syndrome were included. The mean age at diagnosis was 43±12 years [21-78]. The mean delay between the previous obstetrical event and the diagnosis of SS was 11 years. Thirty-four patients (28%) gave birth at home. All patients had a history of obstetric hemorrhage, 79 cases (64%) had blood transfusion and 16 cases (13%) had undergone peripartum hysterectomy. The most frequent symptoms were asthenia in 108 cases (87%), amenorrhea in 106 cases (86%), agalactia in 102 cases (86%) and loss of pubic and axillary pilosity in 44 cases (36%). At diagnosis, 93% (n=115) had corticotropic deficiency, 93% (n=104/112) had gonadotropin deficiency, 91% (n=113/123) had thyrotropic deficiency, and 86% (n=112) had lactotropic deficiency. The somatotropic axis was investigated in 42%(n=51) of patients, and somatotropic deficiency was found in all of them. Sheehan’s syndrome was diagnosed relatively late (>1 year) in 100 patients. We found that the majority of multiparous patients 83%(n=83) consulted late (P=10^-3). More than half the patients who consulted early (n=17/23) had a history of blood transfusions (P=10^-3).

Conclusions: Early diagnosis of SS based on our clinical findings is important for proper management of these patients through multidisciplinary collaboration between obstetricians and endocrinologists. In addition, special attention and strict follow-up are required for all women presenting with massive hemorrhage in the last trimester, in order to identify cases of SS.