Endocrine Abstracts

Sheehan syndrome (SS) caused by postpartum hemorrhage leads to varying degrees of pituitary insufficiency. With improved obstetrical care, ischemic pituitary necrosis is less common and, as a consequence, most cases of SS are being overlooked and diagnosis is delayed for years due to its nonspecific signs and symptoms. Data regarding the relationship between hypopituitarism and increased risk of venous thrombosis are inconsistent and need to be elucidated further. A 41-years-old woman presented with swollen leg and profound fatigue. Venous doppler revealed left crural deep vein thrombosis and the treatment with anticoagulants was started. Initial laboratory analysis suggested hypothyroidism with TSH 5.76 IU/ml, free T4<5.15 ng/dl, free T3<2.30 ng/dl with negative thyroid-specific antibodies so the patient was placed on levothyroxine (100 mg daily) and referred to endocrinologist. Further evaluation was obtained two months after and revealed the presence of iatrogenic hyperthyroidism (TSH 0.10 IU/ml, free T4 19.44 ng/dl) together with secondary adrenal insufficiency and growth hormone deficiency (GH <0.1 ng/ml). Endocrinology review showed a past history of postpartum hemorrhage after third delivery 6 years ago. Pituitary magnetic resonance imaging (MRI) revealed an empty sella. A diagnosis of SS was made and patient placed on oral glucocorticoid therapy together with modified dose of levothyroxine. A typical presentation of SS include a long period of time between the puerperal hemorrhage and the diagnosis of hypopituitarism. A detailed obstetrical history is needed in order to recognize the pattern and avoid the initiation of thyroid hormone replacement before complete evaluation of pituitary function.