A case of Sheehan's syndrome associated with severe anemia and empty sella proved 48 years after postpartum hemorrhage

A 68-year-old woman was admitted to our hospital for severe normochromic and normocytic anemia. She had a history of prolonged postpartum hemorrhage at the age of 20 yr. Her menses were resumed thereafter and she gave birth to two other children, but her lactation was poor. She had no subjective symptom until the age of 63 yr when she complained of weakness and cold intolerance. Laboratory examination at admission revealed severe anemia (Hb 7.2 g/dl) with relatively low serum erythropoietin (EPO 20.4 mIU/ml) and panhypopituitarism. Empty sella was also found by magnetic resonance imaging (MRI). Hb levels were corrected by replacement with levothyroxine (75 mu g/day) and hydrocortisone (10 mg/day), which was accompanied by an increase in serum EPO levels. These findings indicate that this is a very rare case of Sheehan's syndrome with severe anemia and empty sella proved at the longest reported interval of 48 yr after the provoking delivery, and that serum EPO levels are increased by replacement with glucocorticoid and thyroxine in panhypopituitarism.