Authors: Daniel Santos Rodrigues , Beatriz Rosa , Carolina Oliveira , Laura Caine , Elsa Goncalves , Carla Lemos Costa

Abstract

Background: Sheehan’s syndrome (SS) is a rare but serious complication of severe postpartum hemorrhage, primarily resulting from ischemic necrosis of the anterior pituitary gland. It leads to varying degrees of hypopituitarism and presents with a broad spectrum of clinical manifestations. Early features typically include agalactia due to prolactin deficiency and persistent amenorrhea. As the condition progresses, patients may develop nonspecific symptoms such as asthenia, fatigue, headache, and pallor. Diagnosis is made by a triad of clinical manifestations, biochemical findings, and imaging.

Case presentation: This report describes the case of a 63-year-old woman presenting with generalized weakness and drowsiness. Laboratory evaluation revealed hyponatremia, hypoglycemia, hypocortisolism, and secondary hypothyroidism. Magnetic resonance imaging demonstrated a partially empty sella.

Conclusion: The average delay in diagnosis of SS has been estimated at nearly two decades, likely due to the high prevalence of vague and nonspecific symptoms in affected women. Increased clinical awareness is essential to improve outcomes and prevent long-term complications associated with this condition. This case underscores that SS can present decades after delivery and that timely hormone replacement is lifesaving.

Keywords: Sheehan’s syndrome; Postpartum pituitary necrosis; Hypopituitarism; Empty sella; Secondary hypothyroidism.