Endocrine Abstracts

Introduction: Panhypopituitarism is characterised by inadequate production of anterior pituitary hormones. It has diverse etiologies, including Sheehan syndrome, defined as anterior pituitary gland necrosis, following significant bleeding post-partum, and may present with non-specific symptoms, making diagnosis challenging. This case captures a delayed diagnosis of panhypopituitarism in a young woman with resultant comorbidities and reduced quality of Life (QOL), and highlights a scenario of both acute and chronic presentation of Sheehan’s syndrome, which is rare in available literatures.

Case Presentation: A 37-year-old female teacher, with fatigue, low mood, recurrent blackouts of 11 years duration; and weight loss of 20 kg over five years. Symptoms were severe leading to resignation from her job. She reported postpartum haemorrhage in her last confinement,15years earlier, which was eventually managed definitely by hysterectomy, after receiving 30 units of blood transfusions. Within a 5-year interval, she received multiple blood transfusions, for recurrent anaemia of unknown origin, until referral to Haematology clinic, from where she was referred to endocrinology clinic. Examination revealed a young woman with sallow look, flat affect, pale, bilateral pitting pedal oedema and Positive Woltman sign PR:80b/m, BP:79/56mmhg. PCV 29.5%, TSH: 3.893uIU/ML (0.38-5.33) FT3:1.68pg/ml (3.6-6.8), FT4 0.63pg/ml (7.2-16.4), ACTH:<5.00 (0-46 pg/ml), 30M cortisol 22.12 (240-618), 60M cortisol 18.77 (240-618), 90M cortisol 20.36(240-618), Prolactin 1.22ng/ml (3.3-26.7). Brain MRI: Empty sella turcica A diagnosis of Panhypopituitarism (2⁰ adrenal insufficiency, 2⁰ hypothyroidism, hypoprolactinaemia, growth hormone deficiency) secondary to Sheehan’s syndrome, was made. She was commenced on Hormone replacement therapy, and counselled on fertility options. Symptoms resolved, with improved QOL, in 8 months of therapy.

Conclusion: There should be a high index suspicion of panhypopituitarism, especially in treatment-resistant anaemia, among women of reproductive age.