# Panhypopituitarism Presenting as Myxedema Coma Unveiling Sheehan's Syndrome

## TL;DR

A woman with a history of postpartum hemorrhage was later diagnosed with Sheehan's syndrome, a rare pituitary disorder, after presenting with myxedema coma and panhypopituitarism.

## Contribution

This case emphasizes the importance of checking free thyroxine levels in diagnosing central hypothyroidism despite normal thyroid stimulating hormone levels.

## Key findings

- The patient had panhypopituitarism and myxedema coma with a history of postpartum hemorrhage.
- Delayed diagnosis occurred due to normal thyroid stimulating hormone levels without free thyroxine testing.
- The case is consistent with Sheehan's syndrome following postpartum hemorrhage 18 years prior.

## Abstract

Myxedema coma (MC) is a rare and life-threatening complication of uncontrolled hypothyroidism. We report a 46-year-old Hispanic female who presented with hemodynamic instability and hyponatremia. She was initially diagnosed with adrenal insufficiency (AI). Further evaluation revealed myxedema features and panhypopituitarism, with partial empty Sella. A thorough history was notable for postpartum hemorrhage 18 years prior and followed by failure of lactation and secondary amenorrhea which is consistent with Sheehan's syndrome. Our case highlights the delayed diagnosis of central hypothyroidism with normal thyroid stimulating hormone levels without checking free thyroxine level and emphasizing the importance of comprehensive evaluation in similar presentations.