Sheehan’s Syndrome: It Is Time to Become More Proactive in Identifying This Disease

Abstract

Sheehan’s syndrome typically occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage and can present with varying degrees of pituitary insufficiency. It is more common in underdeveloped countries, and is frequently diagnosed years after delivery due to its nonspecific signs and symptoms. Failure to lactate is a common initial symptom, while many women also report amenorrhea or oligomenorrhea. This article presents a 26-year-old female with a history of hypertension, who presented to the hospital for diarrhea, vomiting, and dizziness. Her blood pressure was 80/40 mmHg, requiring aggressive fluid resuscitation, after which it remained borderline. Further testing resulted in an ACTH stimulation test with inadequate response, secondary hypothyroidism, and low prolactin. Her menstrual period could not be assessed due to daily progesterone therapy for contraception. MRI of the brain showed an empty sella, after which she was diagnosed with Sheehan’s syndrome, and started on hydrocortisone and levothyroxine.

Keywords

• Sheehan’s syndrome
• postpartum hypopituitarism
• postpartum pituitary gland necrosis
• transient hypotension