Crise mixedematosa como manifestação tardia da Síndrome de Sheehan em paciente com Lúpus Eritematoso Sistêmico: Um relato de caso

Abstract

Sheehan's Syndrome (SS) is a rare cause of hypopituitarism resulting from pituitary necrosis after severe postpartum hemorrhage. Its presentation can be insidious, leading to delayed diagnosis. We report the case of a 43-year-old female patient with a history of postpartum hemorrhage 24 years prior, admitted in serious condition with a decreased level of consciousness, asthenia, and delirium. Laboratory and imaging investigation confirmed panhypopituitarism, including central hypothyroidism, secondary adrenal insufficiency, and hypogonadotropic hypogonadism. Magnetic resonance imaging revealed a partially empty sella turcica, corroborating the diagnosis of SS. The acute condition was characterized as a myxedema crisis, precipitated by the voluntary suspension of levothyroxine for 75 days. During hospitalization, the investigation of pancytopenia associated with positive serological markers led to the concomitant diagnosis of Systemic Lupus Erythematosus (SLE). Treatment with hormone replacement and corticosteroid therapy resulted in significant clinical improvement. This report highlights myxedema crisis as a severe and late complication of SS, emphasizing the importance of therapeutic adherence and discussing the diagnostic complexity in the coexistence of multiple autoimmune diseases.