Endocrine Abstracts

JOINT159

Introduction: Sheehan’s syndrome is a rare but potentially serious complication of the post-partum period. It involves ischaemic necrosis of the anterior pituitary gland secondary to a sudden and/or prolonged state of shock during a delivery haemorrhage.

Case report: A 59-year-old patient with a history of iron deficiency anemia and dyslipidemia over the past 2 years. She was consulted for major asthenia associated with chilliness and chronic constipation. Examination revealed bradycardia and a thyroid work-up showed TSH at 0.7 U/lwith low FT4 <0.42 ng/dl. Questioning revealed a history of haemorrhagic childbirth 15 years ago with absence of lactation and seondary amenorrhoea. An 8-hour cortisol test showed 23 ng/ml and hypogonadotropic hypogonadism. The MRI showed an arachnoidocele. The patient was substituted.

Discussion: The incidence of this condition is underestimated because diagnosis is often late, made more than ten years after the obstetric event in 50% of cases. Furthermore, it is estimated that around 25% of women who die within the first 30 days post-partum have developed clinical signs of pituitary necrosis. There is an abundance of literature concerning the discovery of Sheehan’s syndrome at a distance from childbirth. However, there have been very few reports of this syndrome being diagnosed in the immediate post-partum period.

Conclusion: Postpartum pituitary necrosis is a difficult diagnosis in the acute phase, often unrecognised. Careful questioning can contribute enormously to the diagnosis and early management of our patients.

References: Eselvier. Volume 23 May 2004, Pages 508-512.