Progressive dementia associated with Sheehan's syndrome--an autopsied case

This is a report of the study of progressive dementia associated with Sheehan's syndrome in a 61-year-old woman who had a 13-year history of insidious progressive decline in global cognitive abilities. At the onset, there were only slight difficulties with abstract thoughts, and a shortened attention span, but the symptoms gradually increased in severity until death at the age of 61. The clinical deficits fluctuated in severity. During the last years of life she was at all times confused, apathetic, and incapable of self-care. A necropsy revealed a moderately severe neuronal loss in the central nervous system with marked destruction of the anterior pituitary lobe, and severe atrophy of the thyroid and adrenal glands. No senile plaques or neurofibrillary tangles were observed in the cerebral cortex. Possible pathophysiological mechanisms, which may have been present in this case, could be the hypometabolic effects on the central nervous system, mediated through a multi-endocrine system malfunction, caused by postpartum uterine hemorrhage and a marked disappearance of the pituitary anterior lobe cells.