A Rare Case of Sheehan Syndrome With Cardiac Tamponade

Abstract

Sheehan syndrome, also called postpartum hypopituitarism, is primarily caused by ischemic necrosis of the pituitary resulting from a complicated pregnancy. As the clinical presentations occur years after the complication, it is difficult to diagnose this condition. In this report, we discuss the case of a 35-year-old female with altered mental status, generalized edema, and loss of appetite. The condition was complicated due to the comorbidities of multiple medical conditions such as massive pericardial effusion and untreated jaundice. Her anorexic condition perfectly masked the malnourished appearance of the patient. After multiple laboratory tests and diagnostic imaging, the empty sella turcica of the patient propounded Sheehan syndrome. Replacement of the deficient hormones improved her condition after two weeks. Patients with complicated pregnancy history should be advised for diagnostic imaging early in life to appropriately manage Sheehan syndrome. A delay in diagnosis can have significant health and financial loss. Hormone replacement therapy is the only viable option as there is no cure to treat necrosed pituitary.

Keywords: hypopituitarism; jaundice; pericardial effusion; sella turcica; sheehan syndrome.

Figure 1. Chest X-ray showing bilaterally enlarged cardiac silhouette (a) and cardiac silhouette after pericardiocentesis (b).

Figure 2. MRI of the mid-sagittal section of the brain showing partially empty sella turcica with a normal stalk (arrows).