A DIAGNOSTIC CHALLENGE: HYPONATREMIA EXPOSING A NEGLECTED CASE OF SHEEHAN'S SYNDROME.

Sheehan's syndrome is defined as infarction of the pituitary gland in the postpartum period typically as a consequence of hypovolemic shock following severe obstetric haemorrhage.Sheehan syndrome clinical presentation is highly variable ranges from non specific complaints such as fatigue , generalised weakness to severe pituitary insufficiency , hence it is often overlooked . In this report ,we discuss a case of 47 year old women who presented with symptomatic hyponatremia , initial evaluation for common causes were unremarkable. Detailed history revealed past obstetric complications including postpartum haemorrhage years prior . Biochemical work up showed secondary adrenal insufficiency , hypothyroidism all other hormones are in the lower normal range. Magnetic resonance imaging showed empty sella , these findings lead to the diagnosis of partial sheehan's syndrome. She had non specific symptoms since decades and recurrent episodes of hyponatremia since 8 years due to delayed diagnosis, sheehans syndrome despite being a rare cause of hyponatremia , physicians should maintain high index of suspicion as unrecognised hypopituitarism can result in potentially life threatening complications.