Pak J Med Sci 2010 Vol. 26 No. 3 www.pjms.com.pk 713 Case Report HYPONATREMIA – A RARE AND EMERGENCY PRESENTATION OF SHEEHAN’S SYNDROME Singhania P 1 , Singh S 2 , Banerj ee R 3 , Singhania B 4 , Banerj ee I 5 , Maitra S 6 ABSTRACT We present the case of a 29 year old female who presented to us with e lectrolyte abnormality, primarily hyponatremia in a setting of diarrhoea and moderate pallor. She had a significant past history of childbirth complicated with post partum haemorrhage after which she developed secondary amenorrhoea. Workup showed suppressed levels of all pituitary hormones and an empty sella on MRI brain. A diagnosis of Sheehan’s syndrome presenting as hyponatremia- a rare but emergency presentation was made. KEY WORDS: Sheehan’s Syndrome, Hyponatremia. Pak J Med Sci July - September 2010 Vol. 26 No. 3 713-715 How to cite this article: Singhania P , Singh S, Banerjee R, Singhania B, Banerjee I, Maitra S.Hyponatremia – A rare and emergency presentation of Sheehan’s Syndrome. Pak J Med Sci 2010;26(3):713-715 1. Singhania P, Postgraduate Student, 2. Singh S, Postgraduate Student, 3. Banerjee R, Assist ant Professor, 4. Singhania Bikash, MBBS, 5. Banerjee Indrayudh, MBBS Student 6. Maitra S, RMO cum Clinical Tutor, 1-3 & 6: Department of Internal Medicine, Medical College Kolkata, West Bengal, India. 5: KPC Medical College, Kolkata - India. Correspondence: Dr. Pankaj Singhania, Room No 12, Bonophool Doctors’ Hostel, Eden Hospital Building, Medical College, 88, College Street, Kolkata 700073. India. E-mail: drpankaj007@hotmail.com * Received for Publication: March 13, 2010 * Revision Received: May 6, 2010 * Revision Accepted: May 12, 2010 INTRODUCTION Sheehan’s syndrome or post partum necrosis of pituitary is very rare complication of post partum haemorrhage. It is generally first suspected as a result of lactational failure post partum and subsequent amenorrhoea. Hyponatremia is rare but acute presentation of Sheehan’s syndrome. The main purpose of this case report is to highlight this under diagnosed entity and a rare presentation of this entity when the diagnosis can be both difficult and costly. CASE REPORT We present the case of a 29 year married (for 14 years) Muslim female, a housewife from a village in Howrah district of West Bengal who presented to us at Medical College, Kolkata. She presented with diarrhoea for three days and gradually deteriorating state of health, drowsiness and diffuse body ache for three days. On examination she was found to be disori- ented, extremely restless and all her limb muscle groups were found to be tense and tender but without signs of inflammation. She had signifi- cant pallor and systemic examination was otherwise found to be normal. Routine investi- gations including electrolytes were ordered and the patient was managed for diarrhoea and electrolyte abnormality.