Sheehan’s Syndrome Presenting as Adrenal Crisis Seven Years After Postpartum Haemorrhage: A Case Report Highlighting the Imperative of Early Endocrine Evaluation

Abstract

Background:
Sheehan’s syndrome is an uncommon but clinically significant cause of anterior pituitary insufficiency arising from ischaemic necrosis of the gland following severe postpartum haemorrhage (PPH). First systematically characterised in 1937, the condition persists as a leading aetiology of secondary hypopituitarism in developing nations where effective obstetric haemorrhage control remains inaccessible to many. The diagnosis is frequently delayed by years because the initial hormone losses are partial, the symptoms are non-specific and insidious, and the precipitating obstetric event may not be volunteered or pursued in subsequent clinical encounters.
Case Report:
A 31-year-old woman (P1D1) attended the emergency department with a one-week history of generalised fatigue, nausea, vomiting, diarrhoea, and diffuse abdominal pain. She had refractory hypotension (BP 80/60 mmHg) and recurrent hypoglycaemia (blood glucose 42 mg/dL). Seven years prior she had sustained severe PPH requiring transfusions and intensive care, after which lactation failed and secondary amenorrhoea persisted without investigation. Hormonal profiling confirmed pan-anterior pituitary insufficiency: LH 0.94 IU/L, FSH 2.53 IU/L, prolactin 3.9 ng/mL, cortisol 3.01 μg/dL, AMH 0.101 ng/mL, and thyroid indices consistent with central hypothyroidism (TSH 2 μIU/mL, T3 11.52 ng/dL, T4 2.84 μg/dL). Haemoglobin was 6.5 g/dL. MRI showed an empty sella confirming pituitary atrophy. Intravenous then oral hydrocortisone (10 mg morning, 5 mg evening) was initiated, followed by levothyroxine 75 mcg daily from day five; haemodynamic instability resolved promptly.
Conclusion:
Sheehan’s syndrome should be actively considered in any woman with a history of significant obstetric haemorrhage presenting with unexplained adrenal crisis, refractory hypotension, or recurrent hypoglycaemia, regardless of the interval since delivery. Targeted hormonal profiling and MRI of the sella turcica are diagnostic. Prompt glucocorticoid