We present a case of severe peripartum hyponatraemia that occurred following a major obstetric haemorrhage causing both an ischaemic stroke and Sheehan's syndrome and outline the investigations and management strategy required.
BunchTJDunnWFBasuA. Hyponatremia and hypoglycemia in acute Sheehan’s syndrome. Gynecol Endocrinol2002; 16: 419–423.
3.
WestonGChavesNBowditchJ. Sheehan's syndrome presenting post-partum with diabetes insipidus. Aust N Z J Obstet Gynaecol2005; 45: 249–250.
4.
HagueWM. Diabetes insipidus in pregnancy. Obstet Med2009; 2: 138–141.
5.
AtmacaHTanriverdiFGokceC. Posterior pituitary function in Sheehan's syndrome. Eur J Endocrinol2007; 156: 563–567.
6.
HuangYYTingMKHsuBR. Demonstration of reserved anterior pituitary function among patients with amenorrhea after postpartum hemorrhage. Gynecol Endocrinol2000; 14: 99–104.
7.
AnfusoSPatrelliTSSonciniE. A case report of Sheehan's syndrome with acute onset, hyponatremia and severe anemia. Acta Biomed2009; 80: 73–76.
8.
MunzWSeufertRKnapsteinPG. Early postpartum hyponatremia in a patient with transient Sheehan's syndrome. Exp Clin Endocrinol Diabetes2004; 112: 278–280.
9.
BoulangerEPagniezDRoueffS. Sheehan syndrome presenting as early post-partum hyponatraemia. Nephrol Dial Transplant1999; 14: 2714–2715.
10.
Del ZottoEGiossiAVolonghiI. Ischaemic stroke during pregnancy and puerperium. Stroke Res Treat2011; 2011: 606780–606780.
11.
JamesAHBushnellCDJamisonMG. Incidence and risk factors for stroke in pregnancy and the puerperium. Obstet Gynecol2005; 106: 509–516.
12.
KamoiKToyamaMTakagiM. Osmoregulation of vasopressin secretion in patients with the syndrome of inappropriate antidiuresis associated with central nervous system disorders. Endocr J1999; 46: 269–277.
13.
MittalRSheftelHDemssieY. Management of hyponatraemia. Br J Hosp Med (Lond)2011; 72: M22–M25.
14.
SchrierRWGrossPGheorghiadeM. for the SALT Investigators. Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med2006; 355: 2099–2112.
15.
PetereitCZabaOTeberI. A rapid and efficient way to manage hyponatremia in patients with SIADH and small cell lung cancer: treatment with tolvaptan. BMC Pulm Med2013; 13: 55–55.