From an obstetric history to severe hyponatremia: Late diagnosis of Sheehan’s syndrome presenting as hypopituitarism. Case report

Sheehan's syndrome is a rare but potentially underdiagnosed cause of acquired hypopituitarism, resulting from ischemic necrosis of the pituitary gland following severe obstetric hemorrhage. Due to the nonspecific and progressive nature of its clinical manifestations, diagnosis may be delayed for years.
We present the case of a 49-year-old woman who presented with a 15-day history of persistent vomiting, asthenia, and paresthesias in the extremities. Initial workups revealed severe hyponatremia and hypochloremia. During the etiological evaluation, central hypothyroidism, hypogonadotropic hypogonadism, and hyperprolactinemia were documented. Physical examination revealed bradypsychia, cold and dry skin, and absence of body hair. Given the suspicion of hypopituitarism, a targeted interview revealed a history of severe postpartum hemorrhage 26 years prior. Magnetic resonance imaging (MRI) of the sella turcica showed findings consistent with an empty sella. Based on the integration of clinical, biochemical, and radiological findings, a diagnosis of hypopituitarism secondary to Sheehan’s syndrome was established.