Pituitary Necrosis Revealed by Central Diabetes Insipidus Secondary to Postpartum Hemorrhagic Shock: A Case Report

Postpartum pituitary necrosis results in Sheehan's syndrome, giving a clinical picture of complete or dissociated panhypopitiutarism. It classically involves the anterior pituitary gland and is rarely associated with central diabetes insipidus. We report the case of a 26 year old primiparous woman admitted to intensive care for haemorrhagic shock secondary to post partum haemorrhage due to cervical tear. After resuscitation and haemodynamic stabilisation, she presented with retro-orbital headaches, an absence of milk production and primary hypotonic polyuria with a negative fluid balance. Fluid restriction without improvement and a positive desmopressin test led to the diagnosis of central diabetes insipidus. As part of the aetiological investigation, magnetic resonance imaging (MRI) showed pituitary necrosis. The presence of central diabetes insipidus in the context of post-partum haemorrhage should raise the possibility of pituitary necrosis, although this association is rare. MRI is a key element in the diagnosis, particularly in the acute phase, as the clinical picture of panhypopuitarism occurs much later.