it was first described in 1937 by sheehan ; it is the ischemic necrosis of the pituitary gland secondary to a brutal and extended shock due to obstetric hemorrhage . a 40 year old patient , g3p3 , with no significant medical or surgical history , was admitted to the intensive care unit with hemorrhagic shock due to postpartum hemorrhage following a normal delivery at home . the clinical examination on arrival confirmed the state of shock : an undetectable blood pressure , a tachycardia of 120 beats / min , cold peripheries , pale conjunctivae and polypnea . immediate care involved vascular expansion with colloids via a central venous catheter , followed by a transfusion of 5 units of cross matched packed red cells since the haemoglobin level was 5g / dl . the short - term evolution was marked by lactational failure and hypoglycemic crisis ( obnubilation , profuse sweats , agitation and convulsions ) confirmed by glycemias of 0,4g / l and relieved by the administration of hypertonic glucose solutions . the medium - term evolution was marked by prolonged amenorrhea , fatigue and apathy . in the light of this clinical picture , sheehan 's syndrome was suspected and confirmed by a pituitary and cerebral mri which showed an empty sella turcica ( figure 1 ) . hormone profiles including cortisol , plasma acth , thyroid hormones , tsh , fsh , lh and prolactin were all low as a result of panhypopituitarism ( cortisol : 40ng / ml , plasma prolactin : 0ng / ml , tsh : 0,05ui / ml , fsh : 0,20mui / ml , lh : 0,1mui / ml , t3 : 2pmol / l , t4 : 4pmol / ml ) . the treatment is essential hormone replacement : thyroxin 50 mg per day , hydrocortisone 40 mg per day . it was first described in 1939 by sheehan . it occurs classically in postpartum hemorrhage with cardiovascular collapse . the diagnosis can be made reliably in the presence of lactational failure , prolonged amenorrhea and hypoglycaemic crises . however , other signs of adenohypophysal insufficiency are often delayed and subtle leading to the diagnosis being missed . in some cases the pituitary necrosis is only partial and the syndrome can present in atypical and incomplete forms further complicating the diagnostic procedure . apart from adenohypophysal necrosis , other causes are quoted : tumoral , immunological , iatrogenic , traumatic , infectious and genetic . the mri scan is the investigation of choice , but there is little data illustrating postpartum hypophyseal necrosis in the acute phase . in case of hypophyseal necrosis , the early mri highlights a pituitary gland of reduced size with segments of hypersignal in t1 and t2 and hyposignal without contrast . corticotropin insufficiency could suggest the concept of low plasmatic cortisol , just as urinary free cortisol and acth would be low . thyroid hormone levels are low . the basic blood level of growth hormone would be low . prolactin levels are important because they are physiologically very high at the end of pregnancy and return to normal approximately 6 weeks postpartum in women who do not breastfeed . dynamic investigations are carried out , making it possible to confirm that target organs are normal and that the fault lies with an absence of activity at the pituitary gland . once the diagnosis is established , treatment aims to correct life threatening endocrine imbalance : hypoglycaemia and adrenal insufficiency being the most urgent , meriting treatment even in anticipation of laboratory confirmation . complete hormonal substitution aims to restore normal function in the thyroid , adrenal and ovarian axes . even if postpartum hemorrhage has been well managed , this complication can not be excluded , and it can be life threatening . it is necessary to consider this diagnosis in all patients having presented with a cardiovascular collapse during childbirth , whatever the cause , and in the presence of the classic signs of pituitary insufficiency .
post - partum pituitary necrosis ( sheehan 's syndrome ) is a rare complication of post - partum hemorrhage . 
 the diagnosis can be erratic and often delayed . in this case report of sheehan 's syndrome in the post - partum period , 
 the signs were characterized by agalactia , severe hypoglycemia , and low serum levels of thyroid hormones , cortico - adrenal hormones , and gonadotrophin ( fsh , lh ) . 
 the hypophyseal magnetic resonance imaging confirmed the diagnosis of hypopituitarism secondary to pituitary necrosis .