A Sheehan’s Syndrome Revealed by Profound Hypoglycemia: A Case Report

A sheehan’s syndrom is characterized by ischemic necrosis of the anterior pituitary gland after postpartum hemorrhage hypopituitarism immediately or after several years. The late discovery of this disease shows that it is not well known and that its clinical and the lack of specificity of its clinical picture. We report the case of a patient whose diagnosis of sheehan's syndrome was delayed and revealed by a profound hypoglycemia. A 30 year old femele patient, admitted to the intensive care unit in a state of disturbed consciousness with profound hypoglycemia at 0.2 g/l according to the family felt by tremor and sweat not yielding to resucration, and sweat septic shock due to pyelonephritis, was intubated, ventilated and put on noradrenaline in SAP and antibiotic therapy, in view of the non-improvement and low blood pressure figures despite the filling and vasoactive drugs, with a hyponatremia of 119 mmol/l and hyperkalemia of 6 .1 mmol/l on the ionogram, acute adrenal insufficiency was suspected and the 8-hour cortisol level confirmed the diagnosis (0.3 ug/dl), patient put on intravenous hydrocortisone hemisuccinate. The evolution was marked by an improvement, patient extubated and weaned from vasoactive drugs, the interrogation revealed an antecedent hemorrhagic childbirth with absence of milking and absence of return of childbirth, and the patient kept an important asthenia in postpartum but and consulted each time for a digestive picture made of abdominal pains and nausea put under symptomatic treatment without the diagnosis of adrenal insufficiency being suspected. The patient was then admitted to the endocrinology department for further management with evidence of a gonadotropic, corticotropic and thyrotropic deficit, the somatotropic axis was not explored, the pituitary MRI was without anomalies. The disease is manifested by corticotropic insufficiency is one of the most important endocrine imbalances because it threatens the vital prognosis. ...