The Woman in a Veil of Sheehan’s Syndrome

Introduction and Importance: Sheehan’s Syndrome (SS) is a condition arising due to postpartum necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery. Patients with SS have varying degrees of anterior pituitary hormone deficiency. Advanced obstetrical care have reduced its incidence. However, it is still a cause of concern in less developed countries. SS often evolves slowly and hence, diagnosed late. History of postpartum hemorrhage, failure to lactate and cessation of menses are important clues to the diagnosis. Early diagnosis and appropriate treatment are important to reduce morbidity and mortality of the patients. Case Presentation: Here, we describe the case of a 36 year-old female who presented in a drowsy state, in the outpatient department, with sudden onset of 6-7 episodes of clear, colourless vomitus since first day. Initial investigations revealed severe hyponatremia with persistent hypoglycemia. Endocrine studies and pituitary magnetic resonance scan revealed Sheehan’s syndrome. She improved significantly once the treatment with hormone replacement therapy was started. Clinical Discussion: Hyponatremia is an initial symptom of acute Sheehan’s syndrome in approximately 60% of the reported cases. Acute hyponatremia can lead to life-threatening cerebral edema. Interestingly, our patient also had recurrent hypoglycemia, a rare presentation. The initial diagnosis depends upon detailed clinical history and physical examination, complemented by relevant laboratory tests and imaging studies. Conclusion: Physicians should be suspicious of hyponatremia and hypoglycemia as it could be an initial manifestation of hypopituitarism of SS. Hence, the causes of persistent hypoglycemia and recurrent hyponatremia should be worked upon in young females.