Addressing Blood Glucose Fluctuations and Fasting Challenges in Sheehan Syndrome: A Case Study

Document Type

Conference Proceeding

Publication Date

10-2024

Publication Title

Journal of the Endocrine Society

Abstract

Introduction: Sheehan's syndrome (SS) is a rare condition characterized by hypopituitarism resulting from ischemic necrosis of the pituitary gland due to severe postpartum hemorrhage. Patients may have hormonal insufficiencies, ranging from single pituitary hormone insufficiency to total hypopituitarism. The diagnosis of SS is often delayed due to its nonspecific signs and symptoms, leading to many undiagnosed and untreated cases. Case Presentation: A 33-year-old African American female with a history of panhypopituitarism secondary to Sheehan Syndrome presented with syncope, lightheadedness, and severe hypoglycemia (blood glucose 12mg/dL). Despite regular food intake, she struggled with glycemic control, experiencing recurrent hypoglycemic episodes associated with nausea, vomiting, unintentional weight loss (25kg), and polydipsia/polyuria. Laboratory findings revealed low ACTH, sodium, cortisol, and elevated liver enzymes, consistent with hypopituitarism. Cosyntropin stimulation test confirmed adrenal insufficiency. MRI showed an empty sella. Initially treated with high-dose hydrocortisone, then transitioned to lower maintenance doses, she continued to experience glycemic fluctuations. Intravenous dextrose and insulin sliding scale were initiated. Upon discharge, she was prescribed hydrocortisone and levothyroxine. Despite adjustments, hypoglycemia persisted, managed with dietary modifications. This case underscores the challenges inmanaging Sheehan Syndrome-associated panhypopituitarism and the need for tailored treatment approaches to achieve metabolic stability. Conclusion: This case underscores the complexities of managing panhypopituitarism secondary to Sheehan syndrome, emphasizing the importance of comprehensive hormonal replacement therapy and thorough monitoring to achieve symptom control and metabolic stability. Tailored treatment regimens and continuous assessments are crucial to addressing individual hormone deficiencies and preventing associated complications effectively in these patients.

Volume

8

Issue

Suppl 1

First Page

A582

Comments

ENDO 2024 Endocrine Society Annual Meeting, June 1-4, 2024, Boston, MA

DOI

10.1210/jendso/bvae163.1121

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