Acute Sheehan Syndrome Manifesting as Unremitting Headache

A 27-year-old female developed severe bifrontal headache and photophobia 2 days after an emergency lower segment cesarean section complicated by massive postpartum hemorrhage (PPH) necessitating aggressive hemodynamic resuscitation. Thereafter, she remained euvolemic. Neurological examination, including visual fields to confrontation, cranial nerves, and fundoscopy, was normal. A noncontrast computed tomography scan on day 2 demonstrated a subtly enlarged pituitary gland with an area of focal hypodensity (Figure 1A). Over the following days, her headaches persisted despite analgesia and she developed lactation failure, but no additional clinical or biochemical features of pituitary dysfunction. Neurological examination remained unchanged. Magnetic resonance imaging on day 5 demonstrated a heterogeneous T2 signal within the enlarged pituitary gland and peripheral rim enhancement (Figure 1B–D), consistent with acute pituitary infarction (Sheehan syndrome)