{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:05:42Z","timestamp":1756339542232,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,8,12]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>A 53-year-old woman was referred for medical evaluation of therapy-resistant dyslipidaemia accompanied by elevated creatine kinase levels. Because cessation or alteration of her medication did not improve laboratory abnormalities, hypothyroidism was considered, despite the fact that thyroid stimulating hormone levels were within the reference interval. On further evaluation, she was found to have panhypopituitarism and empty sella turcica as shown by MRI. These findings were unexpected since there was no clinical suspicion during detailed evaluation. When supplementary questions were asked, she brought up a history of severe postpartum haemorrhage 30 years ago, for which she underwent a hysterectomy. Based on these findings, the patient was diagnosed with Sheehan\u2019s syndrome. This syndrome is a rare but potentially life-threatening complication of postpartum haemorrhage, characterised by varying degrees of hypopituitarism that are most commonly presented many years after delivery. The patient recovered after adequate hormone replacement therapy.<\/jats:p>","DOI":"10.1136\/bcr-2021-243992","type":"journal-article","created":{"date-parts":[[2021,8,25]],"date-time":"2021-08-25T13:11:09Z","timestamp":1629897069000},"page":"e243992","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Misleading normal TSH and persistently elevated creatine kinase: clues to the diagnosis of chronic Sheehan\u2019s syndrome"],"prefix":"10.1136","volume":"14","author":[{"given":"Ay\u015fe Y","family":"Demir","sequence":"first","affiliation":[{"name":"Clinical Chemistry and Haematology, Meander Medical Centre, Amersfoort, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine P","family":"Oldenburg-Ligtenberg","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Meander Medical Centre, Amersfoort, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bianca Loredana","family":"Toma-Stan","sequence":"additional","affiliation":[{"name":"Clinical Chemistry and Haematology, Meander Medical Centre, Amersfoort, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert","family":"van de Wiel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Meander Medical Centre, Amersfoort, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,8,25]]},"reference":[{"key":"2025082709094900000_14.8.e243992.1","unstructured":"Hormone replacement in hypopituitarism guideline resources, 2016. 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