Successful diagnosis and management of Sheehan’s syndrome without MRI: A case report

Abstract

Introduction

Sheehan’s syndrome is a rare but serious condition caused by ischemic necrosis of the pituitary gland following severe postpartum hemorrhage. It is often underdiagnosed, particularly in low-resource settings, due to limited access to laboratory and imaging facilities. The condition leads to varying degrees of pituitary hormone deficiency, manifesting as fatigue, hypotension, lactation failure, and menstrual irregularities. In postpartum women presenting with hypotension, differentials such as hemorrhage, sepsis, cardiomyopathy, and adrenal insufficiency should be considered. Early recognition and hormone replacement therapy are crucial for preventing life-threatening complications.

Case presentation

A 24-year-old Ugandan woman presented with fatigue, dizziness, hypotension, and an inability to lactate three days after a home delivery complicated by significant postpartum blood loss. She was lethargic and had a blood pressure of 90/60 mmHg. Laboratory investigations revealed panhypopituitarism, with markedly reduced levels of cortisol, ACTH, TSH, free T4, FSH, LH, estrogen, prolactin, and IGF-1. A diagnosis of Sheehan’s syndrome was established based on clinical and biochemical findings.

The patient was initiated on hormone replacement therapy with hydrocortisone and levothyroxine. Over four months, her symptoms resolved, and follow-up testing showed clinical improvement with partial biochemical stabilization under hormone replacement therapy.

Conclusion

Sheehan’s syndrome remains an underrecognized cause of postpartum endocrine failure, particularly in resource-limited settings. This case highlights the need for heightened clinical suspicion and timely hormonal assessment in postpartum women presenting with unexplained fatigue, hypotension, and lactation failure. Early diagnosis and appropriate management can significantly improve outcomes, emphasizing the need for increased awareness among healthcare providers.