Introduction: Sheehans 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 Sheehans 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. Sheehans 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 Sheehans 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 Sheehans 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 Sheehans 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.
03 - 07 May 2008
European Society of Endocrinology