A Case of Sheehan Syndrome 7 Years Postpartum with Transaminitis and Hyperlipidemia

Abstract

Patient: Female, 46-year-old Final Diagnosis: Sheehan syndrome Symptoms: Fatigue • light-headedness Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Rare disease Background: Sheehan syndrome (pituitary necrosis after postpartum hemorrhage) can present in various ways, depending on the hormones that are deficient. There may be a long delay to diagnosis of over a decade because symptoms are often vague and pituitary dysfunction progresses gradually. We describe a case of a patient with acute presentation of Sheehan syndrome 7 years after the obstetric event and with no clear precipitating event. Case Report: A 46-year-old woman with a history of hyperlipidemia and transaminitis came to the clinic for evaluation of hypotension and syncope. She had a history of longstanding anhedonia, fatigue, and postpartum hemorrhage 7 years previously and had undergone medical evaluations with her primary doctor with no cause found. Laboratory results showed anemia, central hypothyroidism, and adrenal insufficiency. A diagnosis of Sheehan syndrome was made. Conclusions: Sheehan syndrome is a rare condition of progressive pituitary dysfunction, which can present with nonspecific symptoms and a myriad of laboratory abnormalities until an adrenal crisis is triggered years after the precipitating event. Screening patients for hypopituitarism by free thyroxine levels and adrenocorticotropic hormone (ACTH) stimulation testing is vital for determining whether hypopituitarism is the cause in the appropriate clinical scenario. Use of thyroid-stimulating hormone levels and morning cortisol testing alone will miss this diagnosis, and free thyroxine levels and ACTH stimulation testing are vital.

Acute pituitary crisis after lumbar surgery: A case report

“…Early recognition of pericardial and chest effusion and its underlying causes is important for improving prognosis and avoiding unnecessary invasive investigations. Hyperlipidemia [7] and psychiatric and neurocognitive impairment [8] are common complications of hypopituitarism; however, in our study, the patient did not present with these symptoms.…”

Sheehan’s Syndrome in a Fifty-Six-Year-Old Woman Presenting With a Retroperitoneal Mass: Perioperative Management During a Major Surgery

“…Patients with SS can present with adrenal crisis, hypoglycemia, and hyponatremia, which could be triggered by an infection or surgery [4]. As a result of hypopituitarism, the mortality rate of patients with SS is 1.2 to 2.17 times higher than that of the general population [5]. For the endocrinologist, the anesthetist and the surgical team, a patient with SS who is scheduled for surgery presents a significant challenge.…”