A Challenging Diagnosis of Sheehan's Syndrome in Non-obstetric Critical Care and Emergency Settings: A Case Series of Five Patients with Varied Presentations

Abstract

Sheehan's syndrome is a life-threatening endocrine emergency seen in postpartum females secondary to ischemic pituitary necrosis. It is a frequent cause of hypopituitarism in developing countries that occurs secondary to postpartum haemorrhage (PPH). Patients with Sheehan's syndrome often present with organ dysfunctions in critical care settings, secondary to stressors precipitating the underlying hormonal deficiencies. The initial clinical picture of Sheehan's syndrome may mimic some other disease, leading to misdiagnosis and diagnostic delay. Strict vigilance, timely diagnosis, and appropriate management are essential to avoid diagnostic delay and to improve the patient outcome. In this case series, we describe 5 cases of previously undiagnosed Sheehan's syndrome (including young, middle aged and postmenopausal females) that presented to critical care and emergency settings with organ failures.

Keywords: Sheehan’s syndrome; hypopituitarism; pituitary necrosis; postpartum haemorrhage.

Fig. 1

(a) Sagittal (red bold arrow) and (b) Coronal T2 weighted (red bold arrow-head) images showing sella filled with CSF and thinned and flattened pituitary (height reduced) lying against floor of sella - partially empty sella. Figure 2: (a) Sagittal T2 weighted (red bold arrow) and (b) Coronal post contrast T1 weighted (red bold arrow-head) images showing reduced pituitary height (2.1mm -as measured between calipers in 2a). Figure 3: (a) Sagittal (red bold arrow) and (b) Coronal T2 weighted (red bold arrow-head) images showing sella filled with CSF and pituitary gland severely thinned, lying flattened against sellar floor.