Sheehan's Syndrome Presenting with Hyponatraemia: A Case Report

Main Article Content

Prasanta Kumar Bhattacharya MBBS MD PhD FICP FACP
Aakash Roy MBBS
Md. Jamil MBBS MD
Pranjal Phukan MBBS MD DM
Kalyan Sarma MBBS


sheehan's syndrome, hyponatraemia


Sheehan syndrome (SS), or post partum necrosis of the pituitary gland, is a rare complication of post partum haemorrhage usually presenting with failure of lactation and subsequent amenorrhoea. We report a case of a 30-year-old woman with history of secondary amenorrhea and lactational failure following childbirth complicated with severe post partum hemorrhage, who presented to us with anemia, hypotension, acute confusion, neuropsychiatric manifestations, abnormal posturing and severe hyponatraemia. Hormonal assays revealed low pituitary hormones, subnormal levels of cortisol and thyroid hormones, with magnetic resonance imaging of the brain suggestive of SS. Hyponatraemia and late onset neuro-psychiatric manifestations are uncommon presentations of SS. Hence, there should be a high index of clinical suspicion for Sheehan’s syndrome in women with secondary amenorrhea and lactational failure following childbirth, who present with late onset neuro-psychiatric manifestations and hyponatremia.
Abstract 489 | PDF Downloads 187 HTML Downloads 424


1. Sheehan HL. Postpartum necrosis of the anterior pituitary. J Path Bacteriol 1937;45:189-214
2. Boulanger E, Pagniez, D, Roueff S, Binaut R, Valat A S, Provost N et al. Sheehan syndrome presenting as early post-partum hyponatraemia. Nephrology Dialysis Transplantation 1999; 14(11):2714-2715.
3. Kelestimur F. Sheehan’s syndrome. Pituitary 2003; 6:181-8.
4. Nussey SS, Whitehead SA. Endo- An integrated Approach. 2001, Part A-1257(under heading Sheehan’s syndrome).
5. Ozbey N, Inanc S, Aral F, Azezli A, Orhan Y, Sencer E et al. (1994). Clinical and laboratory evaluation of 40 patients with Sheehan’s syndrome. Israel Journal of Medical Sciences 1994; 30(11):826-29.
6. Sert M, Tetik T, Kirim S, Kocak M. Clinical report of 28 Patients with Sheehan’s syndrome. Endocr J 2003; 50:297-301.
7. Dökmetaş HS, Kilicli F, Korkmaz S, Yonem O. Characteristic features of 20 patients with Sheehan’s syndrome. Gynecol Endocrinol 2006; 22:279-83
8. Gei-Guardia O, Soto-Herrera E, Gei-Brealey A, Chen-Ku CH. Sheehan’s Syndrome in Costa Rica: Clinical experience on 60 cases. Endocr Pract 2010; 1:1-27.
9. Shoji M, Kimura T, Ota K. Cortical laminar necrosis and central pontine myelinolysis in a patient with Sheehan syndrome and severe hyponatremia. Intern Med 1996; 35:427–31.
10. Putterman C, Almog Y, Caraco Y, Gross DJ, Ben-Chetrit E. Inappropriate secretion of antidiuretic hormone in Sheehan’s syndrome: A rare cause of postpartum hyponatremia. Am J Obstet Gynecol 1991; 165(5 Pt 1):1330–33.
11. Schrager, S., & Sabo, L. Sheehan syndrome: a rare complication of postpartum hemorrhage. The Journal of the American Board of Family Practice 2001; 14(5): 389-91.
12. Kurtulmus N, Yarman S. Hyponatremia as the presenting manifestation of Sheehan’s syndrome in elderly patients. Aging Clin Exp Res 2006; 18: 536–9
13. Dejager S, Gerber S, Foubert L, Turpin G. Sheehan syndrome differential diagnosis in the acute phase. J Intern Med 1998; 244:261–266.