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Logo of bmjcrInstructions for authorsCurrent ToCBMJ Case Reports
BMJ Case Rep. 2010; 2010: bcr09.2009.2276.
Published online May 6, 2010. doi:  10.1136/bcr.09.2009.2276
PMCID: PMC3047277
Unusual presentation of more common disease/injury
Practice of symptomatic treatment in the era of evidence-based medicine: report of 2 cases of diagnosis of Sheehan’s syndrome delayed till eighth decade
Abdul Majid Wani,1 Waleed Mohd Hussain,1 Mousa Ali Al Mejally,1 Abdulhakeem Amroon Banjar,1 Khaled Shawkat Ali,1 Amer Mohd Khoujah,2 Sadeya Hanif Raja,1 Mazen G Bafaraj,2 Wail Al Miamini,1 and Mubeena Akhtar1
1Hera General Hospital, Makkah, 21955, Saudi Arabia
2Umm Al-Qura University, Makkah, 21955, Saudi Arabia
Correspondence to Abdul Majid Wani, dr_wani_majid/at/
Sheehan’s syndrome, first described in 1937, is characterised by postpartum haemorrhage, pituitary necrosis, lactational failure and hypopitutarism. Presentation is variable and late presentations are not unusual due to partial ischaemic injury of the pituitary and gradual loss of endocrine function. A history of postpartum haemorrhage is usual but in some cases it is not elicited. Presentations such as malaise, fatigue, hypoglycaemia, decline in cognition, hyponatraemia, pancytopoenia, osteoporosis, secondary infertility, confusion and coma have all been reported. Two interesting cases of Sheehan’s syndrome are presented that were diagnosed in the eighth decade; one due to atypical presentation of recurrent hyponatraemia and confusion, another from hypoglycaemic coma and symptoms of malaise and lethargy.
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