Sheehan’s syndrome presenting after 18 years of ischemic insult as adrenal insufficiency and unmasking of diabetes insipidus: a case report.

Introduction: Sheehan's syndrome is hypopituitarism due to pituitary gland necrosis resulting from hemorrhagic shock during pregnancy. It is a rare complication with varied manifestations and a considerable delay in diagnosis. Case Presentation: We present the case of of a 38 year old woman, who presented to emergency with complaints of acute abdomen and decreased sensorium. She had no previous treatment history. On haematological and radiological assessment, she was diagnosed to be a case of Sheehan’s syndrome with primary insult 18 years back. Investigations: Patient was investigated for all the hormonal axis- LH, FSH, Estradiol for HPO axis , Thyroid Profile, ACTH and Cortisol for HPA axis. Brain imaging using Pituitary protocol was done, which found complete Empty sella. Discussion: Patient was treated with replacement therapy for steroid and thyroid axis, which lead to unmasking of Diabetes Insipidus as free water clearance improved, desmopressin supplementation. There was a rapid improvement in patient outlook within one week of institution of therapy. Conclusion: Previous case reports describe patients being diagnosed after one or more complications from long-term panhypopituitarism. The present case illustrates that undiagnosed Sheehan's syndrome is associated with long-term morbidity, and we want to emphasize that a high index of suspicion is crucial for the early diagnosis of the syndrome in routine clinical visits in order to prevent complications arising with delayed diagnosis. Awareness among clinicians is also essential so that such cases are not overlooked, especially in developing nations, where home delivery is still common and obstetric care is limited.