Endocrinology — MCQs

Q: What is the management of choice for a case of Sheehan syndrome presenting with unresponsive hypotension?

Hydrocortisone. ***Hydrocortisone*** - **Unresponsive hypotension** in Sheehan syndrome is often due to **adrenal insufficiency** (ACTH deficiency), which requires immediate corticosteroid replacement [1]. - **Hydrocortisone** rapidly replaces cortisol, which is crucial for maintaining vascular tone and preventing hypotensive shock [1]. *Thyroxine* - While **hypothyroidism** can occur in Sheehan syndrome, **thyroxine** replacement acts slowly and is not an appropriate initial treatment for acute, life-threatening hypotension [1]. - Correcting profound hypotension takes precedence over addressing thyroid hormone deficiencies in an emergency. *Labetalol* - **Labetalol** is an **antihypertensive** agent that would worsen hypotension in a patient with Sheehan syndrome and adrenal crisis. - It would further decrease blood pressure and compromise circulation. *Epinephrine* - **Epinephrine** is a potent **vasopressor** and might be considered in extreme shock, but it is not the primary treatment for hypotension due to adrenal insufficiency. - Without adequate cortisol, the body is less responsive to catecholamines, making steroid replacement essential first.

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