Unseen Endocrine Deficits: Clinical Diversity in Sheehan’s Syndrome Presentation

Abstract

Background: Sheehan’s syndrome (SS) is postpartum hypopituitarism resulting from ischemic necrosis of the pituitary gland after severe postpartum hemorrhage. It remains underdiagnosed in developing countries due to variable clinical presentation and non-specific symptoms, leading to delayed diagnosis and significant morbidity.

Objective: To evaluate the clinical features, hormonal deficiencies, and radiological findings in patients with Sheehan’s syndrome and to highlight occult endocrine abnormalities responsible for diagnostic delay.

Methods: This descriptive case series was conducted at Patna Medical College and Hospital (PMCH), Patna, India, between December 2024 and August 2025. Five female patients with a history of significant postpartum hemorrhage, clinical features of hypopituitarism, and confirmatory hormonal and magnetic resonance imaging (MRI) findings were included. Clinical assessment, hormonal evaluation, and pituitary MRI were performed. Patients were followed for one month after initiation of hormone replacement therapy.

Results: All patients presented with lactation failure and secondary amenorrhea. Fatigue, cold intolerance, and postural hypotension were common. Hyponatremia occurred in three patients and hypoglycemia in two. Secondary adrenal insufficiency and central hypothyroidism were present in all cases, with variable gonadotropin and prolactin deficiencies. MRI revealed partial or complete empty sella in all patients. Hormone replacement therapy resulted in marked clinical and biochemical improvement, with one patient resuming spontaneous menstruation.

Conclusion: Sheehan’s syndrome shows heterogeneous endocrine involvement and often mimics non-specific disorders. Early endocrine evaluation in high-risk postpartum women is crucial for timely diagnosis and prevention of life-threatening complications.