Recurrent hypoglycaemia: a delayed presentation of Sheehan syndrome.
Sheehan syndrome is a rare but potentially serious complication of postpartum haemorrhage. The diagnosis can often be delayed by many years as symptoms may be subtle. We report the case of a 45-year-old woman who presented to the medical emergency unit with acute onset altered sensorium. On further evaluation she was found to have severe hypoglycaemia which was corrected by giving intravenous dextrose. On detailed clinical evaluation, she had a history of agalactia and amenorrhoea following her last pregnancy which was 15 years ago. She had a history of excessive postpartum bleeding during her last delivery. MRI of the brain showed empty sella and hormonal evaluation revealed adenohypophyseal insufficiency as evident from decreased levels of cortisol, thyroid-stimulating hormone, triiodothyronine, free thyroxine, follicle-stimulating hormone, luteinising hormone and prolactin. Based on clinical, radiological and laboratory parameters her final diagnosis was Sheehan syndrome with hypoglycaemia.
Department of Medicine, Maulana Azad Medical College, New Delhi, India.
Naresh
N
Kumar
Department of Medicine, North DMC Medical College, Delhi, India.
Pratap
P
Singh
Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India.
Jyoti
J
Kumar
Medicine and Endocrinology Division, Maulana Azad Medical College, New Delhi, India.
Dinesh Kumar
DK
Dhanwal
D001774:Blood Chemical Analysis; D001786:Blood Glucose / Q000032:analysis*; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D007003:Hypoglycemia / Q000175:diagnosis* / Q000628:therapy; D007018:Hypopituitarism / Q000175:diagnosis* / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D012894:Sleep Stages; D013974:Thyroxine / Q000008:administration & dosage; D016896:Treatment Outcome
D001786:Blood Glucose; D011239:Prednisolone; D013974:Thyroxine; D006854:Hydrocortisone