Management of a patient with extensive burns and Sheehan's syndrome

Abstract

A 56-year-old woman, weighing 49 kg, suffered flame burns of 42% total body surface area (26% full thickness) affecting her face, extremities, trunk and buttocks, on 7 January 2012. After being rescued from the (house) fire, she received a tracheotomy and intravenous fluid resuscitation at the local hospital, and then she was transferred to our burn department 4 h postburn. She had a premedical history of Sheehan’s syndrome with symptoms of fatigue, cold intolerance, menstruation irregularities, weight loss and recurrent nausea and vomiting, which occurred about 5 years after her postpartum haemorrhage. Laboratory findings of low values of free T4, thyroid stimulating hormone (TSH) and morning cortisol provided hormonal evidence of hypopituitarism. She had been under hormone replacement therapy (50 mg thyroxin and 25 mg cortisone daily) for about 20 years. However, for some unknown reasons, the relatives of the patient did not mention this pre-existing medical condition until the pituitary crisis occurred on the second week post-burn. Despite administration of intravenous fluids using Rui Jin Hospital’s formula of 1.5 ml kg 1 %burn 1 in the first 24 h, with a ratio of 1:1 for Ringer’s Lactate and plasma (one half of total