-A 31 years-old, female

-She has 4 children all delivered by C.S.

-In the last one she had twins, delivered by C.S. delivery with post-partum haemorrhage, and there was no lactation

-she complained of weight loss, coldness, blurred vision, headache, dizziness and hypotension. She repeatedly received I.V. fluids as an emergency measure.

-She complained for almost 2 years and she had hair loss, cold intolerance and dysarthria.

-On emergency presentation:

-she had generalized bony aches

-blood pressure: 70/30

-heart rate: 80 bpm

-T.L.C.: 19.000/mm³

-pyuria

-Discussion:

-This patient obviously had a Sheehan's syndrome. She developed acute pituitary crisis induced by urinary tract infection

-In pregnancy, pituitary gland increases in size with fixed blood supply, so any change in gland perfusion results in immediate damage, causing variable forms of Sheehan's; either rapidly or gradually.

-This condition is induced with stressful conditions like infections

-Emergency treatment: by administration of steroids

-In this case: morning cortisol level:2.6 mcg/dl, ACTH: 1.6 pg/dl, besides deficient other hormones levels: thyroid and sex hormones

-These hormonal deficiencies caused multi-organs dysfunction, e.g. hypoglycemia

-It's to be noted that adrenal replacement should be initiated prior to thyroid replacement not to develop severe adrenal crisis

-The patient's condition improved markedly on wise replacement therapy