Sheehan syndrome with reversible dilated cardiomyopathy

Area of Science:

• Endocrinology
• Cardiology
• Reproductive Medicine

Background:

• Sheehan syndrome is a rare condition characterized by hypopituitarism due to postpartum pituitary necrosis.
• Cardiac abnormalities, such as dilated cardiomyopathy, are infrequently associated with Sheehan syndrome.
• This case highlights a rare presentation of dilated cardiomyopathy in a patient with Sheehan syndrome.

Observation:

• A 25-year-old woman with Sheehan syndrome presented with lactation failure, amenorrhea, hypothyroidism, and hypocortisolism after severe postpartum hemorrhage.
• She developed shock suggestive of hypocortisol crisis after initiating antitubercular treatment for pulmonary tuberculosis.
• Investigations revealed panhypopituitarism, partial empty sella, and echocardiographic evidence of dilated cardiomyopathy (DCM).

Findings:

• Hormone replacement therapy with levothyroxine and prednisolone, alongside antitubercular treatment, was initiated.
• The patient showed significant clinical improvement.
• Follow-up over 7 months demonstrated complete reversal of dilated cardiomyopathy.

Implications:

• This case suggests that dilated cardiomyopathy in Sheehan syndrome may be reversible with appropriate hormone replacement therapy.
• It underscores the importance of cardiac evaluation in patients with Sheehan syndrome.
• This is the first reported instance of reversible DCM in a patient with Sheehan syndrome, offering new insights into pituitary-cardiac axis interactions.