title: Post-partum pituitary insufficiency and livedo reticularis presenting a diagnostic challenge in a resource limited setting in Tanzania: a case report, clinical discussion and brief review of existing literature.
abstract: BACKGROUND
  Pituitary disorders following pregnancy are an important yet under reported clinical entity in the developing world. Conversely, post partum panhypopituitarism has a more devastating impact on women in such settings due to high fertility rates, poor obstetric care and scarcity of diagnostic and therapeutic resources available.
  
  
  METHODS
  A 37 year old African female presented ten years post partum with features of multiple endocrine deficiencies including hypothyroidism, hypoadrenalism, lactation failure and secondary amenorrhea. In addition she had clinical features of an underlying autoimmune condition. These included a history of post-partum thyroiditis, alopecia areata, livedo reticularis and deranged coagulation indices. A remarkable clinical response followed appropriate hormone replacement therapy including steroids. This constellation has never been reported before; we therefore present an interesting clinical discussion including a brief review of existing literature.
  
  
  CONCLUSIONS
  Post partum pituitary insufficiency is an under-reported condition of immense clinical importance especially in the developing world. A high clinical index of suspicion is vital to ensure an early and correct diagnosis which will have a direct bearing on management and patient outcome.
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania. fsheriff.md@gmail.com.
authors.forename: Faheem G
authors.initials: FG
authors.lastname: Sheriff
authors.forename: William P
authors.initials: WP
authors.lastname: Howlett
authors.forename: Kajiru G
authors.initials: KG
authors.lastname: Kilonzo