Sheehan’s Syndrome presenting as postpartum psychosis

@#Sheehan’s syndrome is characterized by hypopituitarism following ischemic necrosis of the pituitary gland caused by postpartum hemorrhage and impaired blood supply to the enlarged pituitary gland during pregnancy. The worldwide prevalence has since decreased due to improvements in obstetric care. Behavioral change is a rare presentation and is often misdiagnosed and managed as psychosis. We report a 42-year-old woman presenting with behavioral changes associated with postpartum failure of lactation and amenorrhea. Hormonal work-up revealed panhypopituitarism; serum cortisol, 98.93 (NV: 138–690 nmol/L); free T4, less than 5.15 (NV: 11.5–23.00 pmol/L); free T3, less than 2.30 (NV: 2.89–4.88 pmol/L); FSH, 3.63 (NV: 30–135 mIU/mL); LH, 3.88 (NV: 13–80 mIU/mL); serum estradiol, 3.89 (NV: 10.41–35.0 pg/mL); IGF-1, 13.13 (NV: 56–194 ng/mL); and serum prolactin, 1.8 (NV: 2.6–24.8 ng/mL). Cranial MRI with contrast revealed an atrophic pituitary gland consistent with Sheehan's syndrome. The symptoms improved substantially upon replacement with steroids and thyroid hormones and she was able to resume her routine activities. The psychiatric features of hypopituitarism can be attributed to a combination of hypothyroidism, hypoglycemia, and hypocortisolism and have been shown to reverse with adequate hormone replacement.

Present Working Impression: Perspectives of Internal Medicine Resident Physicians in a COVID-19 Referral Hospital in Manila, Philippines

@#As the new batch of physicians in the Department of Medicine of the Philippine General Hospital, University of the Philippines Manila (UP-PGH) started their residency in January 2020, COVID-19 was only a disease that was heard of in the news, as it was spreading in China. When the first few patients with coughs and colds would ask us whether it was nCOV (as it was known then), we would not even consider it; we just gently reassured them. Then, the first patient in the country with COVID-19 was admitted on the last week of January 2020,1 prompting various local and national efforts to try to prevent its further spread. Even then, hospital operations and training activities went on as usual except that more people wore masks and practiced social distancing. When the government declared community quarantine for the whole of Luzon mid-March due to the rise in confirmed cases, hospital operations slowed down as the outpatient department (OPD) was closed and workforce was minimized. Before the month ended, the hospital would be designated to be one of the COVID-19 referral centers.