Thread by @IndiaESI

Tracking a mystery to the pituitary gland. A thread

A 58 year old woman presented with vomiting and altered sensorium. Her sodium on presentation elsewhere was 102. She was diagnosed with hypovolemic hyponatremia.

She was rehydrated and discharged when sodium normalised. 3 months later, she presented again with hyponatremia and altered sensorium. Na - 103. TSH was 2 ( normal). Since the TSH was normal, pituitary pathology was ruled out and she was treated as SIADH.

She presented again, 4 months later with hypotension , vomiting and hyponatremia. Sodium - 102 meq/L.

Endocrine consultation was sought

A simple history revealed that she stopped menstruating right after the birth of her second child.

This is Sheehan’s syndrome. Sheehan’s syndrome is a condition in which the pituitary gland function is affected after severe postpartum hemorrhage.

TSH being normal earlier was wrongly interpreted. On evaluation, her T3, T4 was low and TSH was inappropriately normal.

It is very important to do a full thyroid profile when central hypothyroidism ( Hypothyroidism due to the pituitary being affected) is suspected

Her 8 am cortisol was 4 ug/dl. Stimulated cortisol was 12 ug/dl. She was started on steroid replacement followed by thyroxine replacement. Needless to say, she never had hyponatremia again.

The pituitary gland is called the master gland of the body as It controls most endocrine glands in the body. Through secretion of its hormones, the pituitary gland controls metabolism, growth, sexual maturation, reproduction, blood pressure and many other vital physical functions

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