Introduction: In our country, Sheehan syndrome is one of the most common causes of pituitary insufficiency in female patients.
Case: A 54-year-old female patient developed cardiac arrest after an elective hip replacement surgery, and after 5 minutes of cardio pulmonary resuscitation, the rhythm returned to normal and the patient was intubated. Since she was hypotensive, she was given the infusion of noradrenaline after dopamine infusion, but despite this treatment, the patient continued hypotension. Her past medical history revealed that she had been using 100 μg LT4 for 1 year due to hypothyroidism and had not ingested her medication for 1 week. The patient had extensive hemorrhaging during the last birth, but no transfusion was performed. She subsequently did not lactate and never resumed menses. The patient was menopausal at the age of 36 years. She is usually hypotensive, tired and fatigued. The patient had hypoglycemia and hypotension. total pituitary insufficiency was considered as a result of evaluation of history and clinical findings. the hormone levels were found as cortizol: 1.22 μg/dl (6.0218.4), Prolactin: 5.13 ng/ml (4.7923.3), FSH:1.87 IU/ml (25.8134.8), LH:0.676 IU/ml (7.758.5), Estradiol:17.96 pg/ml (5.0138), IGF-1:<15 ng/dl (94252), ACTH:12.3 pg/ml (046), sT4:0.3 ng/ml (0.931.7), TSH:2.58 mIU/ml. (0.44.1). The patient was diagnosed with Sheehans syndrome and adrenal crisis. After basal blood withdrawal, hydrocortisone 400 μg and L-thyroxine 50 μg was started. When the clinical improvement improved, the dose was reduced to 10+5+10 mg / day oral hydrocortisone. The patient was discharged after the sick day rule was told to himself and his family.
Conclusion: If TSH is normal or low in patients diagnosed with hypothyroidism, central causes should be investigated and questioned in terms of obstetric history and panhypopituitaryism.
18 - 21 May 2019
European Society of Endocrinology