Sheehan’s Syndrome Presenting with Panhypopituitarism: Diagnostic Insights from Two Cases and the Role of Laboratory Protocols

A bstract Sheehan’s syndrome (SS) is an important cause of acquired hypopituitarism resulting from postpartum pituitary necrosis. Its presentation is often subtle and nonspecific, leading to prolonged diagnostic delays. Central hypothyroidism may be the earliest biochemical clue, yet it is frequently overlooked because thyroid-stimulating hormone (TSH), the commonly used screening test for thyroid dysfunction, is typically normal or low. We describe two women with a history of postpartum hemorrhage who presented years later with fatigue and weakness and were ultimately diagnosed with panhypopituitarism due to SS. In the first case, an institutional laboratory protocol flagged discordant thyroid function tests, low T3 and T4 with an inappropriately normal TSH, prompting timely endocrine referral. In the second case, empirical levothyroxine therapy without prior assessment of adrenal function led to clinical deterioration, emphasizing the need to evaluate the hypothalamic–pituitary–adrenal axis before initiating thyroid hormone therapy. These cases illustrate the diagnostic value of recognizing discordant thyroid function patterns and highlight the importance of clinician awareness of SS in women with prior postpartum hemorrhage. Early recognition and structured hormonal evaluation are essential to prevent diagnostic delays and avoid potentially life-threatening complications.