MON-024 A Case Report Of Sheehan’s Syndrome With AVP deficiency

Abstract Disclosure: L.R. Nair: None. C.H. Salcedo: None. P. Seabrook: None. A. Wynn: None. D. James: None. Introduction: Postpartum hemorrhage (PPH) leading to pituitary infarction and hypofunction has been identified in the past. Hypopituitarism may take weeks, months or years to manifest. It is rare to have pituitary deficiencies occur within 24 hours of PPH with associated AVP deficiency. Case discussion: 27-year-old female with no significant past medical history, gravida 4 para 3, was transferred from an outside hospital following preterm premature rupture of membrane at 17 weeks of gestation and preterm labor. She was emergently taken to the operating room (OR) with intention of cesarian section, but it was converted to hysterectomy given severe PPH and concern for placenta accreta. She had intraoperative blood loss of about 11 liters requiring massive blood transfusion. She received 14 units of packed cells, 6 units fresh frozen plasma, 2 platelets, and 2 cryoprecipitates. She was intubated in the OR and continued ventilator post operatively. She required hemodynamic support with norepinephrine drip despite adequate control of blood loss after OR and fluid resuscitation on post op day 1. Subsequently, pituitary function labs were ordered. Random cortisol level was 0.4 (4.8-19mcg/dl). She was started intravenous stress dose hydrocortisone. ACTH level was <1.5 (7.2-63.3pg/ml). TSH was 1.49 (0.27-4.2, IU/ml) Free T4 1.10 (0.9-1.68ng/dl), TT3 0.99 (0.8-2 ng/ml), prolactin level was 33 (4.8-23.3ng/ml), IGF1 51 ng/ml (91-308 ng/ml), estradiol 56.7pg/ml, FSH 1.3milliunits/ml, LH <0.3 milliunits/ml. She was extubated and stabilized hemodynamically, and norepinephrine drip was weaned off. She subsequently had increased urine output (creatinine was 0.6mg/dl, blood glucose was 91mg/dl, corrected calcium was 8.6mg/dl). She had measured urine output of 2600ml within 3 hours after starting hydrocortisone. Urine osmolality (UO) was 276 (300-900 mosm) and serum osmolality was 287 (278-305mOsm/kg) serum sodium was 144 (136-146 mmol/L). She was given 1 microgram of desmopressin intravenously with resolution of polyuria and UO improved to 685 mosm. MRI brain with and without contrast showed normal brain parenchyma with no pituitary abnormality. She was discharged on day 3 on desmopressin 0.1 mg to take orally at bedtime and hydrocortisone 20 mg orally in am and 10 mg in pm dose with anticipation of close follow up in 1 week. Discussion: Preceding postpartum hemorrhage with hypotension requiring massive blood transfusion was classic in this case. Patient evidently had adrenal insufficiency with very low random cortisol in the background of stress and hypotension. Treating adrenal insufficiency probably unmasked her vasopressin deficiency. It is unclear whether she will have recovery of pituitary function. She needs follow-up on her thyroid, gonadal, growth hormone axis in 6 weeks. She will also need a repeat pituitary MRI in coming months if hormone deficiencies are found to be persisting. Presentation: Monday, July 14, 2025