This document summarizes the medical history and examination of a 49-year-old woman presenting with vomiting, increased tiredness, and dry cough over the past few weeks. Her history revealed hypothyroidism, premature menopause at age 41 without evaluation, and failure to lactate after her third pregnancy. Her examination found pallor, drowsiness, and laboratory results consistent with hypopituitarism affecting the thyroid, adrenal, and gonadal axes. The diagnosis was panhypopituitarism secondary to Sheehan's syndrome.

1. A case of Hypopituitarism

2. • Mrs Selin, 49 year old House wife
• k/c/o Hypothyroidism/DLP/GERD

3. Presenting complaints
• Vomiting x multiple episodes x 1 week
• Increased Tiredness x 1 week
• Dry cough x 3 weeks

4. History of presenting complaints
• Prior to this presentation she was recently
admitted and evaluated in KMCH Coimbatore
for vomiting and unresponsiveness, in feb
2023. After 1 week of hospital stay, pt got
discharged on request.
• Pt was reportedly normal for next 2 weeks,
then again started vomiting

5. • h/o slow movement and slow speech +
• h/o facial edema, and periorbital edema+
• h/o dry skin +, loss of hair +
• h/o c/c fatigue +, anorexia +

6. • No h/o dyspnoea, head ache, visual
disturbances
• No h/o weight loss, hyper pigmentation
• No h/o cold intolerance
• no h/o ascites, galactorhea, breast atrophy
• No h/o head trauma/surgery/radiation
• No h/o abdominal pain/chest pain
• No h/o infertility

7. • No h/o hoarseness of voice, constipation/
weight gain, sleep disturbance
• No h/o poyuria/polydipsia,nocturia

8. Past medical history
• h/o abortion in first pregnancy
• h/o lactation failure after third pregnancy

9. Personal history
• Premature menopause at 41 years of age, not
evaluated
• Lives with husband and daughter
• Non veg by diet

10. Examination
• Pt drowsy
• Afebrile, pallor +
• PR 84, Bp 100/74, RR 22, SpO2 98
• CVS S1S2+ no murmurs
• RS b/l air entry +, NVBS+
• P/A non tender
• CNS NO FND

11. Investigations
CBC
• Hb 8.7, TC 4300, N 69.6, L 22.3, M 5.3, E 2.3
• Plt 2.6 L
• URE NAD
• Procal 1.7
• CRP 1.6
RFT Ur 7, Cr 0.7, UA 1.5
• NA 107, K 3.3, Cl 78, Ca 7.9, Mg 2
LFT OT 43, Pt14
• ALP 84
• T bili 0.6
• D bil 0.1, indirect 0.;5
• CPK MB 8.1
• Trop T .02

12. • Serum osmolality 221, urine osmolality 169
• Cortisol 3.8
• Urine sodium 37
• TSH 1.3, FT4 0.11, FT3 0.71, TPO 41
• T chol 189, TG 174,HDl 38, LDL 116
• VLDL 35
• Iron 123, IBC 101, b12 5344
• Ferritin 796

13. • FSH
• LH
• ACTH
• S cortisol

14. • ANA profile- negative
• ECG- T inv v1-v4
• ECHO- RWMA , god lv function EF 62%
• USG abdomen-Normal study
• CXR- normal study

15. • 1. Lack of FSH LH
• 1. Hypogonadim amenorrhea
• 2. hypothyroidism
• 3. Ladrenocortical insufficiency
• 4. Prolactin deficiency -FAILURE OF
POSTPARTUM LACTATION

16. Summary

17. Diagnosis
• Pan hypopituitarism
• Secondary to sheehans syndrome