A rare presentation of Sheehan's syndrome with recurrent hypoglycemia: A case report

Sheehan syndrome is a rare but potentially fatal cause of hypopituitarism resulting from ischemic necrosis of the anterior pituitary following severe postpartum hemorrhage. Because symptoms often develop gradually and nonspecifically, diagnosis is frequently delayed until acute illness precipitates adrenal crisis or severe hypoglycemia.

A 48-year-old woman presented with central chest pain, productive cough, dyspnea, intermittent fever, severe anemia, and recurrent hypoglycemia. She had a history of severe postpartum hemorrhage 20 years earlier, followed by secondary amenorrhea and agalactia.

Physical examination revealed basal crepitations. Laboratory investigations demonstrated microcytic hypochromic anemia, leukocytosis with neutrophilia, hyponatremia, markedly low morning cortisol (0.6 µg/dL), low FT3 and FT4, and low-normal TSH, consistent with panhypopituitarism. Based on the obstetric history and hormonal profile, a diagnosis of Sheehan syndrome was established.

The patient was treated with glucocorticoid replacement therapy, followed by levothyroxine supplementation. Supportive management for the respiratory tract infection and hypoglycemia was also provided.

The patient showed significant clinical improvement after initiation of hormonal replacement therapy, with stabilization of blood glucose levels and improvement in systemic symptoms.

This case highlights the prolonged latency between postpartum hemorrhage and presentation of Sheehan syndrome, with acute infection acting as a trigger for adrenal insufficiency. Clinicians should maintain high suspicion for Sheehan syndrome in women with a history of complicated delivery, lactation failure, amenorrhea, and chronic endocrine symptoms, even decades after the inciting event. Early recognition and prompt hormone replacement are lifesaving.