Late-onset Sheehan's syndrome: a major diagnostic challenge-a case report

Sheehan's syndrome is a form of maternal hypopituitarism resulting from excessive blood loss during or after childbirth. This extensive bleeding may reduce blood flow to the pituitary gland, causing pituitary cell damage and death (necrosis). The incidence of Sheehan's syndrome has decreased in developed countries, whereas in developing countries, it remains a substantial cause of morbidity and mortality among at-risk populations.

We describe the case of a 59-year-old patient of mestizo ethnicity, with an unusual presentation of Sheehan's syndrome 38 years after postpartum hemorrhage that affected hormone secretion at the adenohypophysis. During hospitalization, central adrenal insufficiency, low free thyroxine levels, decreased pituitary gland size, hypogonadotropic hypogonadism, and growth hormone deficiency were noted. The patient was treated with hydrocortisone and levothyroxine, with satisfactory clinical progress and improvement in her quality of life.

Late-onset Sheehan's syndrome is a progressive disease, with nonspecific symptoms, which leads to delayed diagnosis and, if not treated in time, may have fatal consequences.