Abstract
Sheehan's syndrome is defined as a postpartum infarction of the pituitary gland following hypovolemic shock due to obstetric hemorrhage. Sheehan's syndrome's symptoms are often subtle, and hence it is often overlooked. In this report, we discuss a case of an 82-year-old woman who developed severe postpartum hemorrhage after her last childbirth at the age of 37, which required multiple blood transfusions. Since then, she had progressively developed malaise and lastly presented with a new onset of confusion. Basic laboratory tests detected poorly controlled hypothyroidism and severe hyponatremia, which are well-known late-presenting conditions of Sheehan's syndrome. Escaping the diagnosis for more than four decades is extremely rare and beyond what is reported previously. Despite being a rare cause of hyponatremia in the elderly, physicians should maintain a high index of suspicion and are required to look for a readily treatable and preventable cause of hyponatremia (after excluding the common causes), which may alleviate the suffering of these patients.