Microprolactinoma in a Woman with Sheehan’s Syndrome

Case Report

Austin J Clin Case Rep. 2014;1(4): 1018.

Microprolactinoma in a Woman with Sheehan’s Syndrome

Deepti Jain*

Department of Obstetrics and Gynecology, Chhotu Ram Hospital, India

*Corresponding author: Deepti Jain, Department of Obstetrics and Gynecology, Chhotu Ram Hospital, 10, 11 Huda complex, Rohtak, Haryana, India

Received: May 20, 2014; Accepted: June 20, 2014; Published: June 23, 2014


A 24 year old woman presented with amenorrhoea and inability to conceive. One and a half year back she had an episode of massive antepartum haemorrhage. Endocrinal work up revealed deficiency of gonadotrophins, central hypothyroidism and paradoxically a very high level of serum prolactin, thus diagnosed as a case of Sheehan’s syndrome with hyperprolactinemia. Magnetic resonance imaging revealed a microadenoma of the pituitary gland. She was treated with thyroxine replacement, dopamine agonist cabergoline and cyclic estrogen and progesterone therapy. Ovulation was augmented with clomiphene citrate. She conceived and a small for gestational age baby was delivered with no apparent anomalies. Postnatally she had adequate lactation contrary to most women with postpartum hypopitiutarism.

Keywords: Sheehan’s Syndrome; Hyperprolactinemia; Gonadotrophins Microprolactinoma


TSH: Thyroid stimulating hormone; MRI: Magnetic Resonance Imaging; T3: Tri-iodo Thyronine; T4: Thyroxine

Case Presentation

A 24year old woman presented on 8th Jan 2010, with secondary amenorrhoea and inability to conceive for the last one and a half year. She had an episode of ante partum haemorhage at 30 weeks of pregnancy, 2 years back. She was rushed to the nearest tertiary care centre where she delivered a preterm fresh still born fetus. Two units of blood transfusion had to be given to combat the hypovolemic shock.

After this episode she started having acyclic menses, occurring after prolonged periods of time, followed by secondary amenorrhea. She had periods once following a course of medroxy progesterone acetate.

Later on, repeated administration of medroxy progesterone failed to induce a withdrawal bleed.


Since progesterone challenge test was already negative, Endocrinal workup was begun (Table 1).

Pelvic ultrasonography was done, which revealed that the uterus was of normal size .However, endometrial thickness was only 1.6mm, suggesting marked estrogen deficiency.