Yadav Prashant, Bari Md Anwarul, Saha Akash, Yadav Sushmita, Khan Amzad H
Department of Medicine.
Sir Salimullah Medical College & Mitford Hospital, Dhaka.
Ann Med Surg (Lond). 2023 Feb 13;85(3):506-513. doi: 10.1097/MS9.0000000000000244. eCollection 2023 Mar.
Sheehan's syndrome is a well-recognized cause of panhypopituitarism secondary to pituitary apoplexy, followed by postpartum hemorrhage. Depending upon the degree of ischemic injury, it can be either partial or complete.
We report an interesting case of a 35-year-old woman admitted to our hospital with complaints of abdominal distension, which was later presumed to be due to disseminated tuberculosis (TB) after excluding the possible differentials. During the treatment course, she was going through repeated attacks of hypovolemic shock and hypoglycemia due to adrenocortical insufficiency. This, along with the history of prolonged amenorrhea 4 years back due to severe postpartum hemorrhage in her last pregnancy, has led us to our diagnosis of partial Sheehan's syndrome. After 1 month of starting steroid and anti-TB therapy, it was quite surprising when she presented with features of pancytopenia and antitubercular drug-induced hepatitis.
Sheehan's syndrome may have a varying degree of presentation depending upon the degree of damage to the pituitary gland, which includes amenorrhea, lactation failure, adrenocortical insufficiency, hyponatremia, hypoglycemia, as well as pancytopenia in some rare instances The hormone panel especially the thyroid profile should be monitored carefully. Such cases are often challenging to deal with because of their varying degrees of presentation and the delay in diagnosis due to a lack of clinical suspicion.
Therefore, we believe that this rare presentation of pancytopenia in Sheehan's syndrome with fluctuating thyroid profile and abdominal TB in the background will let clinicians approach such a rare disease differently.
席汉综合征是垂体卒中继发全垂体功能减退的一种公认病因，继发于产后出血。根据缺血损伤的程度，可为部分性或完全性。
我们报告一例有趣的病例，一名35岁女性因腹胀入院，排除可能的鉴别诊断后，后来推测是播散性结核病（TB）所致。在治疗过程中，她因肾上腺皮质功能不全反复发生低血容量性休克和低血糖。这一点，再加上她上一次怀孕时因严重产后出血导致4年前长期闭经的病史，使我们诊断为部分性席汉综合征。在开始使用类固醇和抗结核治疗1个月后，当她出现全血细胞减少和抗结核药物性肝炎的症状时，令人十分惊讶。
席汉综合征的表现程度可能因垂体损伤程度而异，包括闭经、泌乳失败、肾上腺皮质功能不全、低钠血症、低血糖，在某些罕见情况下还包括全血细胞减少。应仔细监测激素指标，尤其是甲状腺指标。由于这些病例表现程度不同且因缺乏临床怀疑导致诊断延迟，处理起来往往具有挑战性。
因此，我们认为，在席汉综合征中这种伴有甲状腺指标波动和腹部TB背景的全血细胞减少的罕见表现，将使临床医生以不同方式处理这种罕见疾病。
