Endocrine Abstracts

Introduction: Sheehan’s syndrome (SS) is a rare but important cause of hypopituitarism, typically triggered by postpartum hemorrhage and pituitary necrosis. It often remains underdiagnosed, particularly in developing countries, due to limited access to proper obstetric care and the prevalence of home deliveries. This case report underscores the importance of recognizing atypical presentations of SS, such as pancytopenia, which can aid in early diagnosis and prompt management.

Case Presentation: A 40-year-old female presented with symptoms of acute abdomen and was initially diagnosed with acalculous cholecystitis. However, further history-taking revealed significant postpartum hemorrhage 18 years prior, raising suspicion of Sheehan’s syndrome. Subsequent investigations confirmed panhypopituitarism, including deficiencies in thyroid, adrenal, and gonadal hormones. Additionally, the patient presented with pancytopenia, an uncommon hematological manifestation of SS.

Discussion: Sheehan’s syndrome is often associated with nonspecific symptoms, leading to delays in diagnosis. In this case, the patient’s acute abdomen symptoms were due to secondary adrenal insufficiency related to panhypopituitarism. The co-occurrence of pancytopenia and hyponatremia added complexity to the diagnosis. Following hormone replacement therapy, the patient showed significant clinical improvement, highlighting the critical role of early detection and treatment.

Conclusion: Sheehan’s syndrome remains a significant yet underdiagnosed cause of panhypopituitarism in developing regions. Rare manifestations such as pancytopenia are often overlooked, further complicating diagnosis. This case emphasizes the need for increased clinical awareness of SS in patients with unexplained hematological abnormalities, especially in areas with high rates of postpartum hemorrhage. Early diagnosis and appropriate hormone replacement can greatly improve patient outcomes and prevent long-term complications of this underrecognized condition.