Pan-Hypopituitarism Secondary to Sheehan’s Syndrome: A Case Report and Review of the Literature

Abstract

Background: Sheehan’s syndrome (SS) is an under-recognised cause of hypopituitarism resulting from ischaemic necrosis of the anterior pituitary gland following severe postpartum haemorrhage (PPH) and circulatory collapse. Despite being preventable with optimal obstetric care, SS remains clinically relevant in low- and middle-income countries where PPH-related maternal morbidity persists.

Case Presentation: We report a 30-year-old woman who presented three years after severe PPH (requiring 11 units of blood transfusion) with progressive fatigue, secondary amenorrhoea, agalactia, significant weight loss, and alopecia. Hormonal evaluation revealed pan-hypopituitarism with markedly low morning serum cortisol (<11 nmol/L), inappropriately low-normal adrenocorticotropic hormone (ACTH; 11 pg/mL), low free thyroxine (<5.15 pmol/L) with a non-elevated thyroid-stimulating hormone (TSH; 0.883 mIU/L), and suppressed gonadotrophins. Cranial magnetic resonance imaging (MRI) demonstrated an empty sella consistent with pituitary atrophy. A diagnosis of SS with secondary adrenal insufficiency, central hypothyroidism, and hypogonadotrophic hypogonadism was established.

Management and Outcome: Sequential hormone replacement—glucocorticoids (prednisolone) followed by levothyroxine. At four-week follow-up, the patient demonstrated significant clinical improvement including weight gain (4 kg), improved energy, and restored appetite, with partial biochemical recovery.

Conclusion: This case illustrates the protracted diagnostic course of SS and reinforces the importance of maintaining clinical suspicion in women with a history of severe PPH who present with multi-axis endocrine dysfunction. Prioritising glucocorticoid over thyroid hormone replacement is essential to prevent adrenal crisis. Systematic long-term endocrinological surveillance is warranted for all confirmed cases.