ABSTRACT
Sheehan syndrome is a rare cause of hypopituitarism characterized by pituitary gland necrosis after postpartum hemorrhage. It is a pertinent cause of maternal morbidity and mortality in developing countries with deficient obstetrical care but is frequently overlooked in developed countries where its occurrence is uncommon. We present the case of a 66-year-old female diagnosed with Sheehan syndrome more than 30 years after her last delivery complicated by postpartum hemorrhage. Although the patient presented several symptoms and signs of pituitary hormonal deficiencies, a diagnosis had never been established before. The complete laboratory analysis revealed a deficiency in the pituitary axis, and the cranial imaging showed an empty sella turcica. Hormonal replacement therapy resolved several impairments in terms of general energy, physical capacity, temperature regulation, skin characteristics, and sexual function. It also improved her cardiovascular and osteoporosis risk, and, most importantly, prevented a potential life-threatening adrenal crisis. This report highlights the subtle manifestations of Sheehan syndrome to help clinicians establish a prompt diagnosis. Even in developed countries such as Portugal, this condition should be regarded as a potential cause of hypopituitarism.
ABSTRACT
Addison's disease is a rare and potentially life-threatening clinical condition that often presents with an insidious onset of nonspecific symptoms and signs, frequently resulting in a significant delay in diagnosis. Clinical presentation usually includes fatigue and electrolyte imbalance disorders such as hyponatremia. However, specific diagnostic features, such as hyperpigmentation, should raise clinical suspicion. This case report describes a 43-year-old Caucasian male who presented with general malaise, fatigue, anorexia, and weight loss (7 Kg in four weeks). On physical examination, he was found to have severe hyperpigmentation of the skin and mucosal surfaces as well as hypotension. Laboratory tests revealed hypoosmolar hyponatremia and serum potassium levels in the upper limit of normal. Findings of high serum adrenocorticotropic hormone (ACTH) and renin, as well as low cortisol and aldosterone levels, helped establish a diagnosis of Addison's disease. After the initiation of treatment, the patient experienced full recovery of symptoms, normalization of hyponatremia, and improvement of hyperpigmentation. Patients with Addison's disease have the potential to resume normal daily activities with a highly functional status. However, this condition requires lifelong follow-up and surveillance.
