title: Varied presentations of Sheehan's syndrome at diagnosis: A review of 18 patients.
abstract: BACKGROUND
  Sheehan's syndrome (SS) occurs due to ischemic pituitary necrosis as a result of severe postpartum hemorrhage (PPH).
  
  
  OBJECTIVE
  The aim of the present study was to review the presenting features of SS at diagnosis.
  
  
  METHODS
  We retrospectively reviewed 18 cases of SS at diagnosis. Presenting clinical features, laboratory data, pituitary hormone deficiencies, and magnetic resonance imaging (MRI) of the sella were analyzed.
  
  
  RESULTS
  Age ranged from 28-71 years with a mean age of 47 ± 14.44 years. Time to diagnosis of SS was 6-33 years with a mean of 15.35 ± 6.74 years. Four (22.2%) patients were referred from emergency for hyponatremia, one each (5.6%) for hypotension, hypoglycemia, and vomiting. Three (16.7%) patients presented with asthenia and weight loss, two (11.1%) with slightly raised thyroid stimulating hormone (TSH). Only six (33.3%) presented with classic features of amenorrhea. None presented with isolated lactational failure or apoplexy after PPH. Seventeen (94.4%) patients had lactational failure; thirteen (72.2%) did not menstruate following last delivery. Lactotroph and gonadotroph failure were present in all at diagnosis but corticotrophs preservation was documented in three (16.7%) and thyrotroph in two (11.1%) patients. Twelve (66.7%) patients had empty sella while six (33.3%) had partial empty sella on MRI.
  
  
  CONCLUSIONS
  SS has variable features at diagnosis and may present to different specialties. The clinical features of hypopituitarism are often subtle, leading to delay in diagnosis. History of PPH, lactational failure and cessation of menses are important clues. Thyrotroph, corticotroph axis may be preserved in some SS patients.
authors.affiliation: Department of Endocrinology, KPC Medical College and Consultant Endocrinologist, Kolkata, India.
authors.forename: Delmalya
authors.initials: D
authors.lastname: Sanyal
authors.forename: Moutusi
authors.initials: M
authors.lastname: Raychaudhuri
keywords: Partial hypopituitarism; Sheehan's syndrome; postpartum hemorrhage
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