Recurrent hypoglycaemia: a delayed presentation of Sheehan syndrome

Abstract

Sheehan syndrome is a rare but potentially serious complication of postpartum haemorrhage. The diagnosis can often be delayed by many years as symptoms may be subtle. We report the case of a 45-year-old woman who presented to the medical emergency unit with acute onset altered sensorium. On further evaluation she was found to have severe hypoglycaemia which was corrected by giving intravenous dextrose. On detailed clinical evaluation, she had a history of agalactia and amenorrhoea following her last pregnancy which was 15 years ago. She had a history of excessive postpartum bleeding during her last delivery. MRI of the brain showed empty sella and hormonal evaluation revealed adenohypophyseal insufficiency as evident from decreased levels of cortisol, thyroid-stimulating hormone, triiodothyronine, free thyroxine, follicle-stimulating hormone, luteinising hormone and prolactin. Based on clinical, radiological and laboratory parameters her final diagnosis was Sheehan syndrome with hypoglycaemia.

Adrenal crisis precipitated by influenza A led to the diagnosis of Sheehan's syndrome 18 years after postpartum hemorrhage

“…Patients with Sheehan's syndrome may present with variable clinical and pathological features at diagnosis. [1][2][3][4][5][6][7][8][9][10][11]24 In a previous study, 55% of patients exhibited panhypopituitarism, whereas 45% exhibited partial hypopituitarism. 2 Depending on the extent of tissue damage, 1 therefore, patients with Sheehan's syndrome may present either an acute or chronic course, and hypopituitarism may be either complete or partial.…”

“…Because endocrinologic abnormalities usually progress very slowly, diagnosis may be delayed due to the nonspecific nature of associated symptoms, such as fatigue, weight loss, nausea, fever, abdominal pain, and muscle pain. [2][3][4][5] Recent advances in obstetric care have helped reduce the incidence of Sheehan's syndrome; however, the prevalence of this disorder remains poorly defined owing to the large number of undiagnosed patients. 6 According to the World Health Organization, approximately 100 000 women worldwide die annually due to Sheehan's syndrome; furthermore, more than three million women worldwide had Sheehan's syndrome in 1996.…”

“…6 According to the World Health Organization, approximately 100 000 women worldwide die annually due to Sheehan's syndrome; furthermore, more than three million women worldwide had Sheehan's syndrome in 1996. 7 This syndrome is often overlooked, even in developed countries, 8,9 resulting in lengthy delays [2][3][4][5][8][9][10][11] in the diagnosis of as much as 48 years. 11 Adrenal crisis is a lethal medical emergency in the absence of prompt treatment.…”

Hypopituitarism: A Rare but Often Neglected Condition

“… 5 , 6 Biochemically hypoglycemia is also a common finding, caused by cortisol and GH deficiency. 7 Other rare presentations are congestive cardiac failure, acute renal failure, and focal neurological deficit. 8 , 9 Anemia, thrombocytopenia, and pancytopenia were also reported in decreasing frequency.…”

The Interplay Between Pituitary Health and Diabetes Mellitus – The Need for ‘Hypophyseo-vigilance’

“…Hypoglycaemia can be a presenting feature of hypopituitarism. 22 It results primarily from hypocortisolism, secondary to defect in ACTH secretion coupled with deficiency of GH.…”