Sheehan's syndrome laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Overview

Lab evaluation gives a picture of partial or panhypopituitarism. Laboratory findings consistent with the diagnosis of Sheehan’s syndrome are including hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, hypophosphatemia, anemia, pancytopenia, eosinophilia, hypoalbuminemia, low fasting plasma glucose, and decreased levels of anterior pituitary hormones (free thyroxine, estradiol, cortisol levels). The most sensitive tests are inadequate prolactin and gonadotropin responses to stimulation.

Laboratory Findings

Laboratory findings consistent with the diagnosis of Sheehan’s syndrome are including:
- Hyponatremia^[1]^[2]^[3]
- Hypokalemia
- Hypocalcemia
- Hypomagnesemia
- Hypophosphatemia
- Anemia^[3]
- Pancytopenia^[4]
- Eosinophilia^[5]
- Hypoalbuminemia
- Low fasting plasma glucose
- Elevated serum SGOT
- Thrombocytopenia
- Decreased levels of anterior pituitary hormones in blood:
  - Low free thyroxine
  - Low estradiol
  - Decreased cortisol levels
Most sensitive tests are inadequate prolactin and gonadotropin responses to stimulation.
ACTH stimulation test is done after 3 months postpartum, as adrenal gland takes 3 months to get atrophied in absence of ACTH stimulation. During this 3 month period, definitive diagnosis of ACTH and GH deficiency can be made by other stimulation tests, such as insulin– or glucagon-induced hypoglycemia.

References

↑ Shoji M, Kimura T, Ota K, Ohta M, Sato K, Yamamoto T, Funyu T, Mori T, Tateyama M, Abe K (1996). “Cortical laminar necrosis and central pontine myelinolysis in a patient with Sheehan syndrome and severe hyponatremia”. Intern. Med. 35 (5): 427–31. PMID 8797063.
↑ Putterman C, Almog Y, Caraco Y, Gross DJ, Ben-Chetrit E (1991). “Inappropriate secretion of antidiuretic hormone in Sheehan’s syndrome: a rare cause of postpartum hyponatremia”. Am. J. Obstet. Gynecol. 165 (5 Pt 1): 1330–3. PMID 1957856.
↑ ^3.0 ^3.1 Anfuso S, Patrelli TS, Soncini E, Chiodera P, Fadda GM, Nardelli GB (2009). “A case report of Sheehan’s syndrome with acute onset, hyponatremia and severe anemia”. Acta Biomed. 80 (1): 73–6. PMID 19705625.
↑ Laway BA, Bhat JR, Mir SA, Khan RS, Lone MI, Zargar AH (2010). “Sheehan’s syndrome with pancytopenia–complete recovery after hormone replacement (case series with review)”. Ann. Hematol. 89 (3): 305–8. doi:10.1007/s00277-009-0804-9. PMID 19697029.
↑ Ratarasarn C, Rajatanavin R, Himathongkam T (1989). “Salient clinical features of Sheehan’s syndrome”. J Med Assoc Thai. 72 (1): 41–7. PMID 2723566.

Overview