SUN-089 The Hidden Fallout of Childbirth: A Missed Sheehan’s Syndrome Leading to Multiple Organ Dysfunction

Abstract Disclosure: R. Khan: None. H. Ramteke: None. M.A. Mohammed: None. S. Dhall: None. G. Dalal: None. D. Sanapala: None. S.R. Ahmed: None. A.A. Mohamed: None. M. Elmekkawi: None. H. Thangavel Balamurugan: None. Y. Maragowdanahalli Somegowda: None. R. Sawadh: None. M.M. Juneja: None. I. Jolly: None. Background: Sheehan’s syndrome, a rare but life-threatening cause of postpartum hypopituitarism, results from ischemic pituitary necrosis due to severe postpartum hemorrhage (PPH). Its nonspecific systemic manifestations often lead to misdiagnosis and delayed treatment, potentially causing multi-organ dysfunction.Clinical Case: A 42-year-old woman presented to the emergency department in an unconscious state. Laboratory findings revealed profound hyponatremia, severe hypoglycemia, anemia, and hypotension. She was resuscitated with IV fluids, dextrose, and blood transfusions. Despite transient improvement, she remained profoundly weak and was discharged. A month later, she was readmitted with severe dyspnea, pleuritic chest pain, and profound weakness. Imaging revealed massive bilateral pleural effusions, leading to empiric anti-tuberculosis therapy and pleurocentesis was performed. The pleural fluid was transudative, and she developed iatrogenic pneumothorax, requiring intercostal drainage. Echocardiography revealed dilated cardiomyopathy (LVEF 30%), necessitating digoxin and diuretics. Her condition worsened, progressing to Type 1 respiratory failure, requiring mechanical ventilation. A critical reassessment identified a history of lactation failure and secondary amenorrhea following severe PPH requiring massive transfusion, raising suspicion for Sheehan's syndrome. Clinical examination revealed pallor, pedal edema, dry skin, and absence of axillary and pubic hair. MRI confirmed an empty sella, and hormonal evaluation showed TSH: 0.3 mIU/L (Ref: 0.3 - 5), T3: 52 mIU/L (Ref: 87 - 186), T4: 2.1 mIU/L (Ref: 4.5 - 12.5), FSH: 1.1 mIU/mL (Ref: 1.4 - 9), LH: 1.3 mIU/mL (Ref: 1.1 - 18.5), Prolactin: 2.7 mIU/mL (Ref: 3 - 25), Cortisol: 3.4 mIU/mL (Ref: 5 - 25), ACTH: 10 pg/mL (Ref: 10 - 25) establishing a diagnosis of Sheehan’s syndrome. Endocrine replacement therapy was initiated with IV hydrocortisone, followed by oral prednisolone (5 mg and 2.5 mg) and thyroxine (50 to 100 mcg). Given her osteoporosis (DEXA T-score -3.0), alendronate, vitamin D, and calcium were added. Within a month, her condition improved dramatically—she was successfully extubated, her pleural effusions resolved, her cardiac function normalized (LVEF 55%), and her osteoporosis improved (DEXA T-score 0). Conclusion: Sheehan’s syndrome can take years or decades to manifest, requiring a high index of suspicion in women with a history of agalactia, hypomenorrhea, or amenorrhea. Detailed obstetric history, attention to psychosomatic symptoms, and comprehensive endocrine evaluation, beyond TSH levels, are crucial for diagnosis. Women with a history of PPH should be closely monitored for hypopituitarism to prevent long-term complications. Presentation: Sunday, July 13, 2025