Delayed Diagnosis of Sheehan’s Syndrome in an 89-Year-Old Female: A Case Report and Review of Literature

TL;DR

An 89-year-old woman was diagnosed with Sheehan's syndrome over 40 years after a severe postpartum hemorrhage, highlighting the long delay in symptom onset and the importance of considering rare causes of hyponatremia.

Contribution

This case report presents the longest documented delay in the clinical presentation of Sheehan's syndrome.

Findings

The patient exhibited hyponatremia and adrenal insufficiency with a history of severe postpartum hemorrhage 46 years prior.

MRI revealed a partially empty sella, and hormonal tests showed deficiencies across all anterior pituitary axes.

The case emphasizes the need to consider Sheehan's syndrome in hypoosmolar hyponatremia unresponsive to rehydration.

Abstract

Sheehan's syndrome, a rare consequence of severe postpartum hemorrhage, is marked by partial or complete deficiencies in pituitary hormones due to pituitary infarction. Patients may not exhibit symptoms for decades, often delaying the pursuit of medical attention. We present the case of an 89-year-old woman who exhibited symptoms of hyponatremia and adrenal insufficiency, with a history of severe postpartum hemorrhage that led to a hysterectomy 46 years ago. Her hormonal panel revealed deficiencies across all anterior pituitary gland axes. MRI findings showed a partially empty sella. To our knowledge, this case has the longest documented delay in presentation, exceeding four decades. It underscores the need to maintain a high clinical suspicion for alternative causes of hypoosmolar hyponatremia, particularly in cases unresponsive to rehydration therapy.

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