Sheehan's syndrome: in vivo diagnosis with the use of computerized axial tomography and pituitary provocative testing

Postpartum amenorrhea associated with other symptoms and signs of hypopituitarism, such as inability to lactate, weakness, easy fatigability, sexual-hair loss, and clinical evidence of hypothyroidism, were found in two female patients with the antecedent of postpartum hemorrhage. The baseline values of the gonadal, thyroid, and glucocorticoid hormones were all consistently lower than normal. The serum levels of the pituitary hormones were low, and the responses to standard stimulatory tests were either insignificant or blunted. Plane skull films and conventional sella tomography did not reveal any abnormality in the sella turcica. CAT identified hypodensity in the area of the hypophysis with preservation of the pituitary stalk. The combination of the failure of provocative stimuli to affect anterior pituitary hormone release with the radiologic picture compatible with pituitary infarction readily makes the diagnosis of Sheehan's syndrome in vivo and should be used in patients where this syndrome is suspected.