Endocrine Abstracts

Introduction: Hypopituitarism due to Sheehan′s syndrome is a rare complication and its diagnosis is often overlooked. The vast majority of people with hypothyroidism have primary hypothyroidism, often due to Hashimoto’s thyroiditis. Coexistence of hypopituitarism and primary hypothyroidism, may accelerate clinical manifestations, mainly those associated with hypothyroidism. Hashimoto′s Thyroiditis with concomitant hypopituitarism is rare but has been described previously, but there are no reports of Hashimoto′s Thyroiditis occurring with Sheehan′s syndrome.

Case report: In this case study, we report a patient with Hashimoto′s Thyroiditis associated with Sheehan′s syndrome. Our case is a 38 –year-old female patient, presented with generalized fatigue, weakness, pain in the muscles of the lower extremities and other nonspecific complaints which were aggravated in recent months. She was consulted with various doctors but with the medication she received, there was no improvement until she presented in poor condition in emergency unit. She gave birth 7 years ago; after delivery she had a history of prolonged bleeding, amenorrhea and inability to lactate. Her physical examination revealed pale, dry, cold, rough skin, sluggish speech and thick voice, decreased body hair. Her laboratory evaluation showed, low levels of free thyroxin (FT4) and free triiodothyronine (FT3), high normal level of thyrotropin stimulating hormone (TSH). Thyroid antibodies were high level. She had hypogonadotropic hypogonadism, hypoprolactinemia, hypocortizolism with low level of adrenocorticotropic hormone and growth hormone deficiency, normochromic normocytic anemia, high level of LDL-cholesterol. Her magnetic resonance imaging was empty sella. Her thyroid ultrasonography revealed aspect of chronic thyroiditis. Our diagnosis was Hypopituitarism due to Sheehan′s syndrome co-existing with Hashimoto′s Thyroiditis. She was treated with hormone replacement and she was in a good condition 2 months later.

Conclusion: A high index of suspicion is crucial for the early diagnosis of the coexistence of hypopituitarism due to Sheehan′s syndrome and Hashimoto′s thyroiditis that is a rare condition in clinical practice, to prevent long-term morbidity.