K. Ishikawa et al., A CASE OF SHEEHANS-SYNDROME ASSOCIATED WITH SEVERE ANEMIA AND EMPTY SELLA PROVED 48 YEARS AFTER POSTPARTUM HEMORRHAGE, Endocrine journal, 42(6), 1995, pp. 803-809
A 68-year-old woman was admitted to our hospital for severe normochrom
ic and normocytic anemia. She had a history of prolonged postpartum he
morrhage at the age of 20 yr. Her menses were resumed thereafter and s
he gave birth to two other children, but her lactation was poor. She h
ad no subjective symptom until the age of 63 yr when she complained of
weakness and cold intolerance. Laboratory examination at admission re
vealed severe anemia (Hb 7.2 g/dl) with relatively low serum erythropo
ietin (EPO 20.4 mIU/ml) and panhypopituitarism. Empty sella was also f
ound by magnetic resonance imaging (MRI). Hb levels were corrected by
replacement with levothyroxine (75 mu g/day) and hydrocortisone (10 mg
/day), which was accompanied by an increase in serum EPO levels. These
findings indicate that this is a very rare case of Sheehan's syndrome
with severe anemia and empty sella proved at the longest reported int
erval of 48 yr after the provoking delivery, and that serum EPO levels
are increased by replacement with glucocorticoid and thyroxine in pan
hypopituitarism.