Abstract
We described a case of 40 year-old lady who presented with a 16 year history of generalized fatigue and recurrent episodes of hypoglycemia. She had a complete clinical evaluation, endocrine studies, and a pituitary magnetic resonance scans that revealed pan-hypopituitarism secondary to Sheehan’s syndrome. She was given hormone replacement therapy, which led to a significant improvement in lethargy, anorexia, muscle weakness, and episodes of hypoglycemia. This case shows the impact of delay in the diagnosis of an easily treatable medical condition and its consequences, especially for the population of a developing country like Ethiopia
Highlights
Sheehan’s syndrome has an insidious course with variable presentations
In developing countries, postpartum pituitary infarction remains a common cause of hypopituitarism [2]
Sheehan’s syndrome can present with acute severe pan-hypopituitarism in some patients, the majority of patients is recognized with a clinical subtle partial pituitary deficiency and their diagnosis and treatments are delayed for many years [3]
Summary
Sheehan’s syndrome has an insidious course with variable presentations. The majority of cases remain undiagnosed for many years after delivery. The history dates back to 16 years when she had had her second child with cesarean section for twin pregnancy with breech presentation after which she had in hospital profuse vaginal bleeding for which she was transfused with 6 units of blood After the delivery, she had failed to lactate and remained amenorrheic since and had never had any gynecologic evaluation. One week prior to her current presentation, she developed bizarre behavior followed by loss of consciousness within two days She was taken to a clinic where her blood glucose level was 39 mg/dl, given dextrose infusion and referred to our hospital. She has no history of head trauma, surgery or irradiation On examination, she was confused with a Glasgow Coma Scale of 14/15, hypotensive with blood pressure 85/50 mmHg, pulse rate 62 beats per minute and afebrile. Reference 7.7 -58.5 (post menopause) 25.8-134.8 (post menopause) 1.6 - 13.9 4.79-23.3 2.5-5 6.2-19.9 0.92-2.33 4.0-6.0 5.0-54.7 (post menopause) 0.1-0.8 (post menopause)
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