AZRA SULTANA , MAJIDAH KHANAM

ABSTRACT

CASE REPORT: 29 years old p1+0 patients seen in our out patient department with complain Of secondary amenorrhea and secondary infertility for 4 years. She informed us that, four years before she delivered a male baby in a private hospital under care of nurse, post delivery she developed postpartum hemorrhage and she bled a large amount of blood. Attending nurse managed her sucessesfully with IV fluids and emergency first aid but she didn’t receive any blood transfusion. In purperium she took iron and multivitamin for 3 month. She started breast feeding to her baby but after 2 month there was no milk ejection in spite of repeated baby suckling .so, she put her baby on top feed and now he is a 4 years old healthy child. Patient also gives history of easy fatigue ability, confusion, difficulty in staying warm, vaginal burning and dysperunia. On examination she was moderately obese lady with rough and coarse skin, vitals within normal limits, no positive finding in systemic examination. Breast, vulva, vagina and uterus showed atrophic changes. A diagnosis of Sheehan syndrome and premature ovarian failure suspected in her case and admitted in ward for further evaluation, on vary next day of admission when she was coming back upstairs in ward after her x-ray skull, she went into hypotensive shock, immediately IV fluid and steroid given her and she became alright. Baseline investigation pituitary profile, x-ray skull and serum estradiol level send to lab. Result of investigation are Hb 8.1gm/dl,platelets and WBC count WNL , Electrolytes and urea also WNL, serum estradiol 80pmol/l,TSH 1.8ng/ml,prolactin 0.5ng/ml. x-ray skull didn’t show enlargement of pituitary fossa. Ultrasound pelvis showed small atrophic uterus with small volume ovaries with tiny follicles. Diagnosis of Sheehan syndrome confirmed and she advised thyroxin 50ìg OD, combined hormone replacement therapy (tab Nova). She follows up after 6 wks in OPD and reported generalized well being and withdrawal bleeding. She counseled about the need of gonadotrophins therapy with or without intrauterine insemination for conception. Additionally she counseled about the need of steroids requirement in stressful life event.

For Full text contact to:
Prof. Dr. Farah Mansuri
editor@annals-ashkmdc.org

Department of Obstetrics & Gynae Baqai Medical University, Karachi