Primary empty sella, hyperprolactinemia, and isolated ACTH deficiency after postpartum hemorrhage

Area of Science:

• Endocrinology
• Reproductive Medicine
• Neuroendocrinology

Background:

• Postpartum pituitary damage, known as Sheehan's syndrome, can lead to hypopituitarism.
• Empty sella and hyperprolactinemia are known endocrine abnormalities.
• Isolated ACTH deficiency causes secondary adrenal insufficiency.

Purpose of the Study:

• To report a unique case of atypical Sheehan's syndrome.
• To highlight the association of empty sella, hyperprolactinemia, and isolated ACTH deficiency.
• To discuss the implications for postpartum endocrine dysfunction.

Main Methods:

• Clinical case presentation and evaluation.
• Hormonal assays including prolactin and ACTH levels.
• Diagnostic imaging (MRI) to assess pituitary and sella turcica.
• Provocative testing (lysine vasopressin) to differentiate pituitary from hypothalamic dysfunction.

Main Results:

• A 20-year-old woman developed galactorrhea, amenorrhea, and hypocortisolism post-delivery.
• Evaluation revealed an empty sella, hyperprolactinemia, and isolated ACTH deficiency.
• The ACTH deficiency was confirmed as pituitary-intrinsic.

Conclusions:

• This case represents a novel presentation of postpartum hypopituitarism.
• The combination of empty sella, hyperprolactinemia, and isolated ACTH deficiency is previously unreported.
• This emphasizes the diverse spectrum of pituitary dysfunction following childbirth.