# Characteristics of the Early Manifestations and the Sequential Changes of Magnetic Resonance Imaging in Acute Sheehan’s Syndrome: A Case Report and Literature Review

## TL;DR

This case report describes a rare postpartum condition, acute Sheehan’s syndrome, highlighting hyponatremia as an early symptom and changing MRI features over time.

## Contribution

The study provides insights into the early clinical manifestations and sequential MRI changes in acute Sheehan’s syndrome through a case report and literature review.

## Key findings

- Hyponatremia was identified as an initial symptom in a case of acute Sheehan’s syndrome.
- MRI showed pituitary gland enhancement at one week, normalization at three months, and atrophy at eight months postpartum.
- The case emphasizes the importance of considering ASS in patients with postpartum hyponatremia and massive hemorrhage.

## Abstract

Acute Sheehan’s syndrome (ASS) is a rare condition that causes pituitary insufficiency in the early postpartum period. In this article, we report a case of early diagnosis of ASS with hyponatremia as the initial symptom. In addition, we review the characteristics of the initial symptoms and sequential changes on magnetic resonance imaging (MRI) based on previous related cases. The patient was a 33-year-old pregnant woman, gravida 2, para 1. She had a vaginal delivery at 40 weeks of gestation, with a total blood loss of 12,700 mL due to atonic bleeding, and, subsequently, she developed a vulvar hematoma. She had a mild comatose, headache, and nausea 30 hours after delivery. The laboratory evaluation revealed hyponatremia (sodium: 128 mEq/L) and mild hypopituitarism (low adrenocorticotropic hormone and low cortisol). The patient was diagnosed with ASS and treated with hormone replacement therapy. MRI examination showed marginal enhancement of the pituitary gland at one week postpartum, normalization at three months, and atrophy at eight months. ASS should be considered when hyponatremia occurs after massive postpartum hemorrhage. It is also important to note that MRI findings in ASS can change during the postpartum period.