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.
Conflict(s) of Interest
References with DOI
1. Sheehan HL. Post-partum necrosis of the anterior pituitary. Irish journal of medical science. 1948(270):241-55. https://doi.org/10.1007/bf02956474
2. Diri H, Karaca Z, Tanriverdi F, Unluhizarci K, Kelestimur F. Sheehan's syndrome: new insights into an old disease. Endocrine. 2016;51(1):22-31. https://doi.org/10.1007/s12020-015-0726-3
3. Diri H, Tanriverdi F, Karaca Z, Senol S, Unluhizarci K, Durak AC, et al. Extensive investigation of 114 patients with Sheehan's syndrome: a continuing disorder. European journal of endocrinology. 2014;171(3):311-8. https://doi.org/10.1530/eje-14-0244
4. Kelestimur F. Sheehan's syndrome. Pituitary. 2003;6(4):181-8. https://doi.org/10.1023/b:pitu.0000023425.20854.8e
5. Tessnow AH, Wilson JD. The changing face of Sheehan's syndrome. The American journal of the medical sciences. 2010;340(5):402-6. https://doi.org/10.1097/maj.0b013e3181f8c6df
6. Gokalp D, Alpagat G, Tuzcu A, Bahceci M, Tuzcu S, Yakut F, et al. Four decades without diagnosis: Sheehan's syndrome, a retrospective analysis. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology. 2016;32(11):904-7. https://doi.org/10.1080/09513590.2016.1190331
7. Kilicli F, Dokmetas HS, Acibucu F. Sheehan's syndrome. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology. 2013;29(4):292-5. https://doi.org/10.3109/09513590.2012.752454
8. Góth A. Sheehan's Syndrome in Association with Diabetes Insipidus. British Medical Journal. 1963;1(5325):240. https://doi.org/10.1136/bmj.1.5325.240
Tovar, Yara E.; Ahmed, Waseem; Urella, Madhulika; Elkadry, Ayman H.; and Khthir, Rodhan A.
"Sheehan’s Syndrome: It Is Time to Become More Proactive in Identifying This Disease,"
Marshall Journal of Medicine:
4, Article 7.
Available at: https://mds.marshall.edu/mjm/vol3/iss4/7