Recurrent symptomatic hypoglycaemia with pancytopenia as a delayed presentation of Sheehan's syndrome with complete recovery after hormone replacement

Abstract

SUMMARYA 38-year-old woman presented to our hospital emergency section in altered sensorium and with blood pressure of 80/60 mm Hg. She gave a history of recurrent episodes of loss of consciousness for 15-20 days, generalised body swelling and generalised weakness for the past 5-6 years. On further evaluation she was found to have severe hypoglycaemic episodes. In view of history of pregnancy and significant blood loss during surgery and long history of lethargy, asthaenia and generalised anasarca, the patient was evaluated for Sheehan's syndrome. Her serum cortisol levels were very low and she was found to have central hypothyroidism. MRI of the brain also revealed small sella turcica and small pituitary gland suggestive of hypopituitarism. The patient was started on high-concentration dextrose drips, steroids and thyroid hormone replacement. The patient showed a marked improvement within 1 week of treatment. And she was discharged with an advice to follow-up at our outpatient department. BACKGROUND

A rare case of pancytopenia causing‐ Sheehan's syndrome: Case report and literature review

“…Early studies showed that the pituitary gland can produce some erythropoietic factors; however, the removal of the posterior lobe of the rat pituitary does not cause anemia, suggesting that, anemia caused by hypopituitary function is caused by the anterior pituitary hormone. 14 , 15 Active thyroid hormone stimulates the formation of red blood cell colonies and growth hormone increases the secretion of erythropoietin. Therefore, anemia can occur when these hormones are deficient.…”

A Case of Sheehan Syndrome Presenting with Pancytopenia and Dilated Cardiomyopathy: A Rare Combination

“…A few cases have also reported haematological abnormalities due to unknown mechanisms, especially anaemia and pancytopenia. 8 Anaemia in these cases could be explained as the effect of pituitary hormone deficiencies and lower oxygen demands, resulting in decreased production of erythropoietin. The mechanism of pancytopenia is unknown due to the rarity of reported cases and a lack of studies , but in the cases studied, other causes were ruled out and the patients responded to hormone replacement.…”

Sheehan’s syndrome in Xinjiang: Clinical characteristics and laboratory evaluation of 97 patients

“…The general laboratory findings in our study, such as hyponatremia, hypoglycemia, anemia and relative lymphocytosis, were consistent with previous reports. [19][20][21][22][23][24][25] One patient in our study had overt central diabetes insipidus (DI): her polyuria had lasted for 5 months after delivery. 24h urinalysis after 12h fluid restriction confirmed a urine density of 1.000 with simultaneous plasma sodium 159mmol/L and osmolality 335 mOsm/kg.…”