Delayed diagnosis and treatment of Sheehan syndrome: a case report.

OBJECTIVE: To report a case of Sheehan syndrome diagnosed and treated nearly 2 decades after a postpartum hemorrhage. DESIGN: Case report. SUBJECTS: A 45-year-old woman presenting with nonspecific symptoms found to have severe hyponatremia and panhypopituitarism 1 month after immigrating from China and 17 years after a postpartum hemorrhage. EXPOSURE: Hormone replacement with hydrocortisone, levothyroxine, and combined oral contraceptive pills. MAIN OUTCOME MEASURES: Clinical and laboratory assessment of central adrenal insufficiency, hypothyroidism, and hypogonadotropic hypogonadism after initiation of treatment. RESULTS: After initiation of hydrocortisone and levothyroxine, the hyponatremia and nonspecific symptoms, including fatigue, dyspnea, nausea, vomiting, myalgias, and brain fog, improved rapidly. Pituitary magnetic resonance imaging demonstrated markedly reduced pituitary volume. Dual-energy x-ray absorptiometry scanning revealed osteopenia. The patient has had 9 months of treatment with cyclic combined oral contraceptive pills without hormonal withdrawal bleeding. Overall, she reports significant improvement in quality of life. CONCLUSION: Postpartum hypopituitarism is widely underdiagnosed with nonspecific presentations and limited access to care contributing to diagnostic delay. Clinicians must maintain a high index of suspicion to diagnose hypopituitarism after a postpartum hemorrhage, even years after delivery. Early initiation of hormone replacement therapy is essential in patients with postpartum hypopituitarism for protection of cardiovascular and bone health.