Lifting the Veil: Delayed Diagnosis of Sheehan Syndrome Unmasked by Adrenal Crisis

We report a 28-year-old woman with refractory hypoglycemia, hypotension, and profound fatigue found to have panhypopituitarism secondary to Sheehan syndrome. Although she had a remote history of postpartum hemorrhage marked by agalactia and secondary amenorrhea, her diagnosis was delayed until she developed an adrenal crisis in the setting of acute pyelonephritis. Comprehensive endocrine testing confirmed secondary adrenal insufficiency, central hypothyroidism, hypogonadotropic hypogonadism, and lactotroph failure; Magnetic resonance imaging demonstrated a partially empty sella consistent with remote pituitary infarction. Prompt initiation of stress-dose glucocorticoids and thyroid hormone led to rapid hemodynamic stabilization and resolution of hypoglycemia. This case underscores the importance of early recognition of subtle hypopituitarism signs-particularly postpartum lactation failure-and the need to consider endocrine etiologies in critical care presentations that mimic septic shock.