Article Text

Download PDFPDF
Misleading normal TSH and persistently elevated creatine kinase: clues to the diagnosis of chronic Sheehan’s syndrome
  1. Ayşe Y Demir1,
  2. Christine P Oldenburg-Ligtenberg2,
  3. Bianca Loredana Toma-Stan1 and
  4. Albert van de Wiel2
  1. 1 Clinical Chemistry and Haematology, Meander Medical Centre, Amersfoort, The Netherlands
  2. 2 Department of Internal Medicine, Meander Medical Centre, Amersfoort, The Netherlands
  1. Correspondence to Dr Ayşe Y Demir; ay.demir{at}meandermc.nl

Abstract

A 53-year-old woman was referred for medical evaluation of therapy-resistant dyslipidaemia accompanied by elevated creatine kinase levels. Because cessation or alteration of her medication did not improve laboratory abnormalities, hypothyroidism was considered, despite the fact that thyroid stimulating hormone levels were within the reference interval. On further evaluation, she was found to have panhypopituitarism and empty sella turcica as shown by MRI. These findings were unexpected since there was no clinical suspicion during detailed evaluation. When supplementary questions were asked, she brought up a history of severe postpartum haemorrhage 30 years ago, for which she underwent a hysterectomy. Based on these findings, the patient was diagnosed with Sheehan’s syndrome. This syndrome is a rare but potentially life-threatening complication of postpartum haemorrhage, characterised by varying degrees of hypopituitarism that are most commonly presented many years after delivery. The patient recovered after adequate hormone replacement therapy.

  • lipid disorders
  • pituitary disorders
  • musculoskeletal and joint disorders
  • obstetrics
  • gynaecology and fertility

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Footnotes

  • Contributors AYD: concept, analysis and preparation of the case report. PCO-L: preparation of the case report, clinician of the case. BLS: preparation of the case report. AvdW: preparation of the case report, clinician of the case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.