Studies have reported a large variation in the time from the suspected pituitary insult to the diagnosis of Sheehan’s, ranging from 1-33 years  and 2-40 years. A review conducted by Huang of 14 patients with postpartum hemorrhage demonstrated severe hyponatremia (serum sodium <125 mmol/l) more than 16 years after the primary event in 8 of the 14 patients. These numbers were not reflected in the review by Sanyal and Raychaudhur, who after examining 18 cases of Sheehan’s syndrome found that only four (22.22%) presented to an emergency department with hyponatremia (all of these patients were over 60 years of age at presentation), however 17 presented with lactational failure and 13 did not menstruate following their last delivery. The study of 20 patients conducted by Dökmetas et al., demonstrated hyponatremia in 35% of the cases studied, where as 70% of the patients lacked post-partum milk production. Both studies showed a lack of menstruation following delivery. Sanyal and Raychaudhur found that 5 of 18 patients had a period of post-partum amenorrhea, on average, for a minimum of 3 years. Although patients most commonly present with failure to lactate or amenorrhea, hyponatremia is the most common electrolyte disturbance. Given the less specific symptoms and signs of hyponatremia, clinicians must be cognisant of the broad clinical spectrum that can signify a diagnosis of Sheehan’s syndrome.

With Regards,
Sara Giselle
Associate Managing Editor
 Journal of Critical Care Obsestrics & Gynocology