Acute Sheehan Syndrome Due to Postpartum Hemorrhage with Hypoglycemia 9 Hours After Cesarean Section: A Case Report and Literature Review.

Sheehan syndrome is a pituitary injury caused by a postpartum hemorrhage that results in hormonal deficiency. Although typically diagnosed later, it rarely presents in the immediate postpartum period. A 35-year-old woman (gravida 4, para 2) underwent emergency cesarean section for placenta previa at 34 weeks of gestation. The total blood loss was estimated to be 4,000 mL. She developed symptomatic hypoglycemia (blood glucose level, 45 mg/dL), followed by drowsiness and hypothermia at 9 h postoperatively. Endocrinological evaluation at 20 h postoperatively showed an adrenocorticotropic hormone level of <1.5 pg/mL, cortisol level of 1.15 µg/dL and free thyroxine level of 0.60 ng/dL. She was diagnosed with acute Sheehan syndrome and was promptly treated with hydrocortisone and levothyroxine. The patient's symptoms resolved rapidly. Multiple anterior pituitary hormone insufficiencies were confirmed. This case underscores the importance of recognizing hypoglycemia as a potential early manifestation of acute Sheehan syndrome, allowing a timely diagnosis and improving clinical outcomes.