Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 8  |  Issue : 2  |  Page : 265-266  

A rare cause of pancytopenia: Sheehan's syndrome


1 Department of Internal Medicine, Malatya State Hospital, Malatya, Turkey
2 Department of Internal Medicine, Findikli State Hospital, Rize, Turkey
3 Department of Emergency Medicine Clinic, Inonu University, Malatya, Turkey
4 Department of Internal Medicine, Sakarya University, Sakarya, Turkey
5 Department of Internal Medicine, Tasliçay State Hospital, Agri, Turkey

Date of Web Publication13-Mar-2015

Correspondence Address:
Selçuk Yaylaci
Department of Internal Medicine, Findikli State Hospital, Rize
Turkey
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.153184

Rights and Permissions
  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. Pancytopenia is rarely observed in patients with Sheehan's syndrome. We present a patient of Sheehan's syndrome presenting with pancytopenia. Complete recovery of pancytopenia was observed after the treatment. Clinicians should consider the possibility of hypopituitarism as a cause of pancytopenia and indicate a series of hormonal examinations. A high index of suspicion is required in women with pancytopenia for possible treatable cause like Sheehan's syndrome.

Keywords: Hypopituitarism, pancytopenia, Sheehan′s syndrome


How to cite this article:
Demir MV, Yaylaci S, Demir TÖ, Temiz T, Genç AB. A rare cause of pancytopenia: Sheehan's syndrome. Med J DY Patil Univ 2015;8:265-6

How to cite this URL:
Demir MV, Yaylaci S, Demir TÖ, Temiz T, Genç AB. A rare cause of pancytopenia: Sheehan's syndrome. Med J DY Patil Univ [serial online] 2015 [cited 2020 Oct 21];8:265-6. Available from: https://www.mjdrdypu.org/text.asp?2015/8/2/265/153184


  Introduction Top


Sheehan's syndrome is characterized by varying degrees of anterior pituitary dysfunction due to postpartum ischemic necrosis of the pituitary gland after massive bleeding. [1] The most frequent hematologic finding is normochromic anemia in Sheehan's syndrome. [2] Pancytopenia is rarely observed in patients with Sheehan's syndrome. [3],[4] We present a patient of Sheehan's syndrome presenting with pancytopenia. Complete recovery of pancytopenia was observed after the treatment.


  Case Repor Top


A 39-year-old woman with complaints of fatigue, malaise, and dyspnea applied internal medicine polyclinic. Pancytopenia was detected, and the patient was hospitalized. Arterial blood pressure was 100/60 mmHg, pulse was 80/min, and body temperature was 35.5 °C. Physical examination revealed no lymphadenopathy and hepatosplenomegaly. Other physical examination was unremarkable. Fasting blood glucose was 60 mg/dl, renal function tests and liver function tests were normal. Physical examination revealed no lymphadenopathy and hepatosplenomegaly. Hemogram showed pancytopenia [Table 1]. Reticulocyte count was 0.4%. Ferritin, serum iron, total iron binding capacity, folic acid, and vitamin B12 levels were normal. Coombs tests were negative. We learned that she had excessive bleeding after her last and third delivery at age 29 and lactation failed and menstruation did not resume after this delivery. Sheehan's syndrome was suspected, and hormone study was made. Hormone profile was consistent with panhypopituitarism [Table 1]. Magnetic resonance imaging of hypophisis showed empty sella [Figure 1]. The diagnosis of Sheehan's syndrome was confirmed with clinic, laboratory, and MR. We started hormone replacement therapy with 0.1 mg L-thyroxine, 7.5 mg prednisolone, 3 mg drospirenone, and 0.03 mg ethinyl estradiol. After 5 weeks of hormone replacement treatment, full hematologic recovery was observed with a eucortisolemic and euthyroid state. The hematologic abnormality had dramatically improved. Her WBC was 7.3 k/μl, her hemoglobin level was 12 g/dL, and her platelet count was 219 × k/ μl, all within the normal range.
Figure 1: MRI of the patient showed empty sella

Click here to view
Table 1: Laboratory results of the patient: Pancytopenia and hormone defi ciency

Click here to view



  Discussion Top


The frequency of Sheehan's syndrome as a cause of panhypopituitarism is reduced due to improvements in obstetric care in developed countries. [1] It is still one of the most important cause of hypopituitarism in Turkey. [3]

Hematological abnormalities in SS have received little attention due to rarity of the disorder in the western countries. Anemia is well recognized as a feature of hypopituitarism. Gokalp et al. have recently reported hematological abnormalities in 65 patients with Sheehan's syndrome, 80% of whom presented with anemia, compared with 25% of controls. [2] A normochromic anemia occurs frequently in the course of Sheehan's syndrome. The anemia associated with hypopituitarism is related to hypocortisolism, hypothyroidism, hypogonadism, and growth hormone deficiency. Pancytopenia is rarely observed in patients with Sheehan's syndrome. There have been few reports of pancytopenia with hypocellular bone marrow associated with Sheehan's syndrome in the literature. [4],[5] Our patients' clinical picture improved dramatically after hormone replacement therapy.

Pancytopenia was detected in our patient, and she was hospitalized. Ferritin, serum iron, total iron binding capacity, folic acid, and vitamin B12 levels were normal. Coombs tests were negative. We learned that she had excessive bleeding after her last and third delivery at age 29 and lactation failed and menstruation did not resume after this delivery. Sheehan's syndrome was suspected, and the diagnosis was confirmed with laboratory and MR. During investigations of pancytopenia, she was diagnosed with Sheehan's syndrome. Cause of pancytopenia in our patient is not understood, but a direct regulatory effect of pituitary hormones on metabolic reactions involved in hemopoiesis has been suggested. [4] In our patient, pancytopenia completely reversed after hormone replacement therapy. Complete recovery of pancytopenia after the hormone replacement therapy was showed that cause of pancytopenia was Sheehan's syndrome in our patient.


  Conclusion Top


Clinicians should consider the possibility of hypopituitarism as a cause of pancytopenia and indicate a series of hormonal examinations. A simple hormone replacement therapy results in complete recovery. A high index of suspicion is required in women with pancytopenia for possible treatable cause like Sheehan's syndrome.

 
  References Top

1.
Keleºtimur F. Sheehan′s syndrome. Pituitary 2003;6:181-8.  Back to cited text no. 1
    
2.
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;88:405-10.  Back to cited text no. 2
    
3.
Ozbey N, Inanc S, Aral F, Azezli A, Orhan Y, Sencer E, et al. Clinical and laboratory evaluation of 40 patients with Sheehan′s syndrome. Isr J Med Sci 1994;30:826-9.  Back to cited text no. 3
    
4.
Kim DY, Kim JH, Park YJ, Jung KH, Chung HS, Shin S, et al.Case of complete recovery of pancytopenia after treatment of hypopituitarism. Ann Hematol 2004;83:309-12.  Back to cited text no. 4
    
5.
Yaylaci S, Demir MV, Aytürk S, Tamer A. Sheehan′s syndrome: Presented with hyponatremia and hypoglycemia after 14 years from delivery. Indian J Endocrinol Metab 2012;16:322-3.  Back to cited text no. 5
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1]


This article has been cited by
1 Herbal approach in the treatment of pancytopenia
Siddhi Manohar Bagwe,Pravin Popatrao Kale,Lokesh Kumar Bhatt,Kedar S. Prabhavalkar
Journal of Complementary and Integrative Medicine. 2017; 14(1)
[Pubmed] | [DOI]



 

Top
   
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Case Repor
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed2717    
    Printed38    
    Emailed0    
    PDF Downloaded200    
    Comments [Add]    
    Cited by others 1    

Recommend this journal