Endocrine Abstracts

Introduction: Sheehan’s syndrome results from postpartum pituitary infarction and is typically associated with major obstetric haemorrhage. However, pituitary injury may also occur with moderate blood loss or perioperative hypotension, leading to subtle postpartum presentations that may delay diagnosis.

Case Presentation: A 42-year-old woman presented eight weeks postpartum following an emergency caesarean delivery of twins at 32+3 weeks. The estimated blood loss during the surgery was 1.5L. She experienced one episode of intraoperative hypotension (SBP 60) which resolved with intravenous fluids; no transfusion or vasopressors were required. She first presented to her GP with lethargy, cold intolerance, reduced appetite and blurred vision and was found to have a cortisol of 56 nmol/l. On admission, she had a blunted response on Short Synacthen test (baseline cortisol 52 →155 → 218 nmol/l) with suppressed ACTH (<1.5 ng/l). Thyroid function demonstrated secondary hypothyroidism [FT4 (7.6 pmol/l) and TSH (0.05 mU/l)]. Gonadotropins were low (FSH 2 IU/l, LH <1 IU/l) with oestradiol <90 pmol/l. Her IGF1 was low (2.6nmol/l). Prolactin and electrolytes were normal. Initially pituitary MRI was reported as normal, but a second review by specialist neuroradiologist identified uniform increased T2 signal and non-enhancing central pituitary tissue with peripheral rim enhancement, consistent with non-haemorrhagic adenohypophyseal infarction in keeping with Sheehan’s syndrome. She was treated with hydrocortisone (100 mg IV loading, then 50 mg QDS, stepped down to maintenance 10–10–5 mg daily), followed by levothyroxine 50 μg daily. Outpatient endocrine follow-up was arranged at discharge.

Discussion: This case highlights early Sheehan’s syndrome in the absence of massive postpartum haemorrhage. Transient hypotension may have contributed to pituitary hypoperfusion, with biochemical and MRI findings confirming evolving hypopituitarism.

Conclusion: Sheehan’s syndrome should be considered in postpartum women with non-specific symptoms and central hormone deficits, even in relatively uncomplicated parturition.