Endocrine Abstracts

Introduction: Sheehan’s syndrome or Simmond’s disease is a partial or complete postpartum hypopituitarism caused by pituitary infraction and necrosis that usually occurs as a complication of massive postpartum hemorrhage or severe hypotension during or after labor and delivery. We present the case of Sheehan’s syndrome presenting postpartum depression.

Case: A 40 years old woman, referred to our department by her psychiatrist for exploration of central hypothyroidism. Her medical history is marked by the occurrence of postpartum depression one month after delivery for which she was put under antidepressant and anxiolytic for about 4 months. Her last pregnancy, the childbirth was a full-term vaginal delivery at home which was complicated with profuse bleeding that required transfusion. The evolution was marked by the inability to lactate her child and the cessation of her menstrual cycles after the delivery. The physical examination at the time of admission revealed an ill-looking patient, bradyphrenia, asthenia, cold extremities, pallor, pronounced wrinkles, rarefaction of body hair and atrophied breasts The biological assessment showed a corticotropic insufficiency with a 8 am cortisol of 26ng/ml, a thyrotropic insufficiency of central origin with FT4 below 1pmol/l and a hormonal profile of hypogonadotropic hypogonadism The hypothalamic-pituitary MRI was requested and came back in favor of an intrasellar arachnoidocele. The patient was put on hydrocortisone, levothyroxine. The evolution was marked by the improvement of her well-being. One month later, she was started on oestrogen and progesterone hormonal therapy.

Discussion & Conclusion: The psychiatric features of hypopituitarism can be attributed to a combination of hypothyroidism, hypoglycemia and hypocortisolism, and have been shown to spontaneously resolve under adequate hormone replacement. In fact, medical and obstetric history, and physical examination are of paramount importance in the diagnosis as most patients will consult for nonspecific symptoms which cause delays in management.