Endocrine Abstracts (2008) 16 P151

Two unusual cases with pancytopenia associated with Sheehan's syndrome

Hulusi Atmaca1,2, Taner Bayraktaroglu1,2, Ayla Gokmen Akoz1,2 & Birsen Unsal Koyuncu1,2


1Medical Faculty, Endocrinology and Metabolism, Zonguldak Karaelmas University, Zonguldak, Kozlu, Turkey; 2Medical Faculty, Hematology, Zonguldak Karaelmas University, Zonguldak, Kozlu, Turkey.


Introduction: Sheehan’s sydrome was known varying degrees of hypopituitarism due to postpartum ischemic necrosis by different etiologies. We report two case who are presented with pancytopenia which is unusual and rarely observed an important clinical finding associated with Sheehan’s syndrome.

Case 1: A 57-year-old woman has complaints of malaise, fatigue, and dyspnea without lymphadenopatia and hepatosplenomagaly. She had excessive bleeding after last delivery at age 36 with subsequently lactation failure and amenorrhea. Endocrinologic evaluation revealed hypopituitarism, and her complete blood count showed anemia, leukopenia and thrombocytopenia due to decreased hematopoiesis with hypocellularity in bone marrow. Sheehan’s sydrome is treated with hormone replacement therapy included prednisolone and L-thyroxine. After three monts of replacement, hematologic findings is fully recovered.

Case 2: Seventy-two-year-old woman is presented with hypoglycemia and pancytopenia, and her physical examination and history of a previous massive postpartum hemorrhage suggested Sheehan’s syndrome. Hormone profiles revealed hypopituitarism, magnetic resonance imaging of pituitary gland showed empty sella. After a week of prednisolone and L-thyroxine replacement therapy, hematologic findings recovered completely.

Conclusion: Pancytopenia is rare complication in association with Sheehan’s sydrome, and devoleped due to loss effect of pituitary hormones on metabolic reactions to hematopoiesis related to hypopituitarism. It was recovered with replacement therapy within a week to 3 months. The diagnosis of Sheehan’s syndrome can be delayed due to slow progression. Obstetric history, menstruation and lactation status must be questinoted and included careful management to avoid postpartum complications.

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