Endocrinol Metab.  2012 Mar;27(1):54-58. 10.3803/EnM.2012.27.1.54.

A Case of Sheehan's Syndrome with Pancytopenia

Affiliations
  • 1Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea. kimhj@dankook.ac.kr

Abstract

Sheehan's syndrome is characterized by varying degrees of anterior pituitary dysfunction due to postpartum ischemic necrosis of the pituitary gland after massive bleeding. The spectrum of clinical presentation of Sheehan's syndrome is broad, with changes from nonspecific complaints, such as weakness, fatigue, and anemia, to severe pituitary insufficiency resulting in coma and death. Normochromic anemia is commonly associated with Sheehan's syndrome, but pancytopenia is rarely observed in patients with Sheehan's syndrome. We describe a 57-year-old woman with Sheehan's syndrome who presented with pancytopenia that was treated by hormone replacement with levothyroxine and glucocorticoid.

Keyword

Glucocorticoids; Hypopituitarism; Pancytopenia; Thyroxine

MeSH Terms

Anemia
Coma
Fatigue
Female
Glucocorticoids
Hemorrhage
Humans
Hypopituitarism
Middle Aged
Necrosis
Pancytopenia
Pituitary Gland
Postpartum Period
Thyroxine
Glucocorticoids
Thyroxine

Figure

  • Fig. 1 Bone marrow biopsy section revealed decreased hematopoiesis with hypocellularity (A, H&E stain, × 40; B, H&E stain, × 100). The overall cellularity is about 10%.

  • Fig. 2 Magnetic resonance imaging of the patient's sella. Pituitary gland was not detected on coronal (A) and sagittal (B) images. Only sella tucica was filled with the cerebrospinal fluid (empty sella).


Reference

1. Kelestimur F. Sheehan's syndrome. Pituitary. 2003. 6:181–188.
2. Gokmen Akoz A, Atmaca H, Ustundag Y, Ozdamar SO. An unusual case of pancytopenia associated with Sheehan's syndrome. Ann Hematol. 2007. 86:307–308.
3. Sheehan HL. Postpartum necrosis of the anterior pituitary. J Pathol Bacteriol. 1937. 45:189–214.
4. Kovacs K. Sheehan syndrome. Lancet. 2003. 361:520–522.
5. Veldhuis JD, Hammond JM. Endocrine function after spontaneous infarction of the human pituitary: report, review, and reappraisal. Endocr Rev. 1980. 1:100–107.
6. Huang YY, Ting MK, Hsu BR, Tsai JS. Demonstration of reserved anterior pituitary function among patients with amenorrhea after postpartum hemorrhage. Gynecol Endocrinol. 2000. 14:99–104.
7. Gokalp D, Tuzcu A, Bahceci M, Arikan S, Bahceci S, Pasa S. Sheehan's syndrome as a rare cause of anaemia secondary to hypopituitarism. Ann Hematol. 2009. 88:405–410.
8. Dökmetaş HS, Kilicli F, Korkmaz S, Yonem O. Characteristic features of 20 patients with Sheehan's syndrome. Gynecol Endocrinol. 2006. 22:279–283.
9. Ferrari E, Ascari E, Bossolo PA, Barosi G. Sheehan's syndrome with complete bone marrow aplasia: long-term results of substitution therapy with hormones. Br J Haematol. 1976. 33:575–582.
10. Ozkan Y, Colak R. Sheehan syndrome: clinical and laboratory evaluation of 20 cases. Neuro Endocrinol Lett. 2005. 26:257–260.
11. Laway BA, Mir SA, Bashir MI, Bhat JR, Samoon J, Zargar AH. Prevalence of hematological abnormalities in patients with Sheehan's syndrome: response to replacement of glucocorticoids and thyroxine. Pituitary. 2011. 14:39–43.
12. Sert M, Tetiker T, Kirim S, Kocak M. Clinical report of 28 patients with Sheehan's syndrome. Endocr J. 2003. 50:297–301.
13. Sohmiya M, Kato Y. Effect of long-term administration of recombinant human growth hormone (rhGH) on plasma erythropoietin (EPO) and haemoglobin levels in anaemic patients with adult GH deficiency. Clin Endocrinol (Oxf). 2001. 55:749–754.
14. Nishioka H, Haraoka J. Hypopituitarism and anemia: effect of replacement therapy with hydrocortisone and/or levothyroxine. J Endocrinol Invest. 2005. 28:528–533.
15. Ozdogan M, Yazicioglu G, Karadogan I, Cevikol C, Karayalcin U, Undar L. Sheehan's syndrome associated with pancytopenia due to marrow aplasia; full recovery with hormone replacement therapy. Int J Clin Pract. 2004. 58:533–535.
16. Kim DY, Kim JH, Park YJ, Jung KH, Chung HS, Shin S, Yun SS, Park S, Kim BK. Case of complete recovery of pancytopenia after treatment of hypopituitarism. Ann Hematol. 2004. 83:309–312.
17. Laway BA, Bhat JR, Mir SA, Khan RS, Lone MI, Zargar AH. Sheehan's syndrome with pancytopenia: complete recovery after hormone replacement (case series with review). Ann Hematol. 2010. 89:305–308.
18. Holmes GI, Shepherd P, Walker JD. Panhypopituitarism secondary to a macroprolactinoma manifesting with pancytopenia: case report and literature review. Endocr Pract. 2011. 17:e32–e36.
19. Laway BA, Mir SA, Bhat JR, Lone MI, Samoon J, Zargar AH. Hematological response of pancytopenia to glucocorticoids in patients with Sheehan's syndrome. Pituitary. 2011. In press.
20. Lee AC. Pancytopenia secondary to hypopituitarism may just be due to hypothyroidism alone. Ann Hematol. 2010. 89:1181.
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