A ray of hope for a woman with Sheehan's syndrome

Abstract

A 25-year-old woman presented with a history of secondary amenorrhoea for the last 3 years, coinciding with her delivery. She delivered at home and had massive postpartum haemorrhage. She was brought in a state of circulatory collapse to the nearest teaching hospital, where she was resuscitated. She developed anaemia, septicaemia and extradural empyema. The complications were managed and the woman improved. Presently, she approached us for infertility. She was investigated and diagnosed with postpartum hypopituitarism, that is, Sheehan's syndrome. Her gonadotrophin levels, luteinising hormone/follicle-stimulating hormone, were normal, serum oestradiol was low and serum prolactin was also on the lower side. She had started with genital atrophy and was given three cycles of cyclic oestrogen +progesterone combination. Ovulation was induced. She conceived and her antenatal period was uneventful. She delivered a full-term baby vaginally. However, she had inadequate lactation after delivery and lost the baby at one-and-a-half months’ age due to gastroenteritis.

Perinatal Management and Outcomes of Pregnancy Following Sheehan Syndrome: A Case Report and Literature Review

“…When and how to terminate the pregnancies following Sheehan syndrome has no consensus. According to previous case reports, the delivery gestational age ranged from 32 weeks to 41 weeks in the 22 pregnancies, 14/22 cases (63.64%) delivered full-term 6,9–19,22,24,26–29 . In the 27 pregnancies which described the delivery mode, 15/27 (55.56%) pregnancies had a vaginal delivery 5,8,10,12,13,15,17,18,24,25,27 and 12/27 (44.44%) terminated by cesarean section 6,7,9,11,14,16,19,25,28,29 .…”

“…According to previous case reports, the delivery gestational age ranged from 32 weeks to 41 weeks in the 22 pregnancies, 14/22 cases (63.64%) delivered full-term. 6,[9][10][11][12][13][14][15][16][17][18][19]22,24,[26][27][28][29] In the 27 pregnancies which described the delivery mode, 15/27 (55.56%) pregnancies had a vaginal delivery 5,8,10,12,13,15,17,18,24,25,27 and 12/27 (44.44%) terminated by cesarean section. 6,7,9,11,14,16,19,25,28,29 Patients with panhypopituitarism or preexisting isolated central DI can get spontaneous delivery.…”

“…To the best of our knowledge, there were 24 papers 5–28 which we can get the full text and one conference abstract 29 published in English after 1950 related to pregnancy following Sheehan syndrome in Pubmed, Medline, Embase, and Google scholar. In the 25 papers and our case, there have been 27 patients with Sheehan syndrome and 32 pregnancies.…”

A decade without diagnosis: Sheehan’s syndrome

“…If the syndrome is early diagnosed and adequate medical therapy is provided, the prognosis of Sheehan's syndrome is excellent [23,24]. On the other hand, if there is delay in identifying and managing these patients, they may present to medical services (at some point after the event of postpartum hemorrhage) with severe and multiple clinical abnormalities-such as adrenal crisis, symptomatic hypoglycemia, symptomatic hyponatremia, among many others [25][26][27].…”