title: Recurrent symptomatic hypoglycaemia with pancytopenia as a delayed presentation of Sheehan's syndrome with complete recovery after hormone replacement.
abstract: A 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.
authors.affiliation: Department of Medicine, Maulana Azad Medical College, New Delhi, India.
authors.forename: Pramila
authors.initials: P
authors.lastname: Dharmshaktu
authors.forename: Jayeeta
authors.initials: J
authors.lastname: Bhowmick
authors.forename: Danny
authors.initials: D
authors.lastname: Manglani
authors.forename: Dinesh Kumar
authors.initials: DK
authors.lastname: Dhanwal
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007018:Hypopituitarism / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D008279:Magnetic Resonance Imaging; D059906:Neuroimaging; D010198:Pancytopenia / Q000209:etiology*; D010902:Pituitary Gland / Q000473:pathology; D012008:Recurrence