A case of hypopituitarism associated with Hashimoto's thyroiditis and candidiasis: lymphocytic hypophysitis or Sheehan's syndrome?

Sheehan's syndrome and lymphocytic hypophysitis often occur in relation to pregnancy, making their differentiation difficult. We describe a 52-yr-old woman with hypopituitarism, Hashimoto's thyroiditis and candidiasis. She was admitted to our hospital because of nausea, vomiting and constipation. Her menstruation stopped in her early thirties. She thereafter developed kyphosis and loss of axillary and pubic hair. Levels of serum Na, Cl and glucose were all low, and hormonal studies were consistent with anterior pituitary hypofunction. Although she had blood transfusion because of hemorrhage at her first delivery, the delivery of her second child was normal followed by resumption of regular menstruation. In addition to hypopituitarism, she had Hashimoto's thyroiditis and candidiasis. Laboratory tests showed an increased Thl ratio, which is related to induction of cellular immunity, and the presence of HLA DR4, which is often associated with polyglandular autoimmune syndrome. These results suggested that the pituitary lesion might be due to lymphocytic hypophysitis rather than Sheehan's syndrome.