SHM Converge Scientific Abstract ePoster Gallery-Don't Forget About Panhypopit: Sheehan Syndrome in a Vulnerable Patient

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This case highlights the importance of considering <strong>panhypopituitarism</strong>, especially <strong>Sheehan syndrome</strong>, in patients with vague but recurrent symptoms such as <strong>fatigue, weakness, cold intolerance, constipation, hair loss, menstrual abnormalities, hypoglycemia, and hypotensive episodes</strong>. Because these symptoms are nonspecific, diagnosis is often delayed.

Common causes of panhypopituitarism include <strong>mass lesions, infarction/hemorrhage, infection, hypophysitis, and Sheehan syndrome</strong>. In this case, a <strong>26-year-old female refugee from Afghanistan</strong> presented with a near-syncopal episode, fever, chills, and tooth pain. She also had cold extremities, weakness, decreased appetite, weight loss, dizziness, and episodes of hypotension and hypoglycemia. Her physical exam showed <strong>cold, pale skin, delayed capillary refill, dry mucous membranes, and global weakness</strong>.

Laboratory findings showed <strong>low glucose, low potassium, undetectable T4, undetectable cortisol, undetectable IGF-1, low prolactin, and low/normal gonadotropins</strong>, supporting pituitary hormone deficiency. MRI demonstrated an <strong>empty sella</strong>, consistent with <strong>Sheehan syndrome</strong>.

The key learning point is to <strong>consider panhypopituitarism in patients with recurrent hypotension or hypoglycemia and in postpartum patients</strong>, particularly those from vulnerable or underserved populations. Clinicians should incorporate <strong>background, history, and sociocultural context</strong> into the evaluation to avoid missing the diagnosis.

Treatment includes hormone replacement with <strong>levothyroxine, prednisone, insulin-like growth factor replacement, and sex hormone replacement</strong> as needed. Early recognition is critical to prevent complications and improve outcomes.

Asset Subtitle

Lauren Dailey

Meta Tag

Author List Haley Briggs, PA-C, Kasey Bowden, Lauren Dailey

Category Clinical Vignettes

Concept Panhypopituitarism

Concept Sheehan Syndrome

Concept Hormone Therapy

Concept Mass Lesion

Concept Pituitary Infarction

Distinguished Non-Finalist

Presenter Organization University of Colorado Division of Hospital Medicine

Presenting Author Lauren Dailey

Track Adult

Keywords

panhypopituitarism

Sheehan syndrome

hypotension

hypoglycemia

empty sella

pituitary hormone deficiency

fatigue

menstrual abnormalities

hormone replacement

postpartum

Panhypopituitarism

Sheehan Syndrome

Hormone Therapy

Mass Lesion

Pituitary Infarction