From acute abdomen to hormonal crisis: Case report on a long-delayed Sheehan's syndrome diagnosis

• Published in: International journal of surgery case reports 2023-10, Vol.111, p.108831, Article 108831
• Main Authors: Adil, Maham Leeza, Alvi, Mahrukh, Khan, Aqsa, Qaiser, Shan Mohammad Mustafa, Osman, Muhammad, Bashir, Muhammad Nauman
• Format: Article
• Language: English
• Subjects: Case Report; Pakistan; Pancytopenia; Panhypopituitarism; Sheehan's syndrome
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2023.108831

Sheehan's syndrome (SS) is a rare cause of hypopituitarism resulting from postpartum haemorrhage and pituitary necrosis. It remains an underdiagnosed condition, especially in developing countries due to poor obstetric care and home deliveries. This case report highlights the significance of recognizing atypical presentations of SS, such as pancytopenia, to aid in early diagnosis and management. A 40-year-old female presented with acute abdomen symptoms and was initially diagnosed with acalculous cholecystitis. However, a detailed history revealed a history of postpartum haemorrhage 18 years prior, leading to a provisional diagnosis of SS. Further investigations confirmed panhypopituitarism, including hypothyroidism, hypocortisolism, and hypogonadism. Notably, the patient also exhibited pancytopenia, a rarely reported haematological manifestation of SS. SS often presents with nonspecific symptoms, leading to delayed or missed diagnoses. In this case, the patient's initial presentation of acute abdomen symptoms was attributed to secondary adrenal insufficiency due to panhypopituitarism. The presence of pancytopenia, along with hyponatremia, further complicated the clinical picture. Hormone replacement therapy led to a remarkable improvement in the patient's condition, emphasizing the importance of early diagnosis and intervention. SS is a common cause of panhypopituitarism in developing countries, but its atypical presentations, such as pancytopenia, are rare and often overlooked. This case highlights the need for increased awareness among clinicians to consider SS in patients with unexplained haematological abnormalities, particularly in regions with high rates of postpartum haemorrhage. Early recognition and appropriate hormone replacement therapy can significantly improve patients' outcomes and prevent long-term complications associated with this underdiagnosed syndrome. •Sheehan's syndrome (SS) is an often-underdiagnosed disease due to its vague symptoms, and variable presentation•One rare presentation of SS is pancytopenia. This presentation has been reported very scarcely in literature, with no reports from Pakistan.•We report a rare case of SS with pancytopenia, with a delayed diagnosis of 18 years.•The patient was successfully managed with hormone replacement therapy, which lead to significant improvement.•This report lays emphasis on early recognition of rare presentations of SS for a quicker diagnosis.