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Background <p>Sheehan syndrome is a rare form of hypopituitarism that occurs due to pituitary necrosis following severe blood loss and hypotension during or after childbirth. The disease is mostly insidious, diagnosed after several years postpartum. However, acute Sheehan syndrome is a life-threatening pituitary hormone deficiency that occurs within 6 weeks of childbirth, associated with seizures, headache, loss of consciousness, and acute adrenal crisis with refractory hypotension, hyponatremia, and hypoglycemia.</p> Case presentation <p>We report a rare case of acute Sheehan syndrome following massive postpartum hemorrhage (PPH) and shock necessitating hysterectomy, during an elective Cesarean section for placenta accreta. The woman in her late thirties presented with altered sensorium and generalized seizures on postpartum day 7, when investigations revealed severe hyponatremia. She also had lactational failure and hormonal evaluation showed evidence of panhypopituitarism with involvement of the lactotroph, corticotroph, and thyrotroph axes. MRI showed a small pituitary with central necrosis, confirming pituitary apoplexy. She improved on hydrocortisone and levothyroxine, but self-discontinued steroids at 3 months postpartum. At one year, she remained asymptomatic, and hormonal evaluation confirmed the recovery of the hypothalamic pituitary adrenal axis and lactotroph axes.</p> Conclusion <p>This case underscores the importance of considering acute Sheehan syndrome in postpartum women with PPH presenting with seizures and hyponatremia and highlights the rare potential for recovery of pituitary function.</p>

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Hyponatremic Seizure in the Postpartum Period – Acute Sheehan Syndrome

  • 期刊论文

  • 发表日期：

    2026年7月13日

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  • Anitha Sebastian,
  • Mukesh Kumar,
  • Jayaprakash Sahoo,
  • Sadishkumar Kamalanathan,
  • Papa Dasari,
  • Dukhabandhu Naik

摘要

Background

Sheehan syndrome is a rare form of hypopituitarism that occurs due to pituitary necrosis following severe blood loss and hypotension during or after childbirth. The disease is mostly insidious, diagnosed after several years postpartum. However, acute Sheehan syndrome is a life-threatening pituitary hormone deficiency that occurs within 6 weeks of childbirth, associated with seizures, headache, loss of consciousness, and acute adrenal crisis with refractory hypotension, hyponatremia, and hypoglycemia.

Case presentation

We report a rare case of acute Sheehan syndrome following massive postpartum hemorrhage (PPH) and shock necessitating hysterectomy, during an elective Cesarean section for placenta accreta. The woman in her late thirties presented with altered sensorium and generalized seizures on postpartum day 7, when investigations revealed severe hyponatremia. She also had lactational failure and hormonal evaluation showed evidence of panhypopituitarism with involvement of the lactotroph, corticotroph, and thyrotroph axes. MRI showed a small pituitary with central necrosis, confirming pituitary apoplexy. She improved on hydrocortisone and levothyroxine, but self-discontinued steroids at 3 months postpartum. At one year, she remained asymptomatic, and hormonal evaluation confirmed the recovery of the hypothalamic pituitary adrenal axis and lactotroph axes.

Conclusion

This case underscores the importance of considering acute Sheehan syndrome in postpartum women with PPH presenting with seizures and hyponatremia and highlights the rare potential for recovery of pituitary function.