A PRESENTATION OF SHEEHANS SYNDROME 22-YEARS LATER. W. Whitwam 1 , D. Stuart 1 ; 1 Hennepin County Medical Center, Minneapolis, MN LEARNING OBJECTIVES: 1) Recognize complications of analgesics associated with unrecognized hypothyroidism. 2) Understand the complications of Sheehan's syndrome and panhypopituitarism. CASE INFORMATION: A 62-year-old African-American female, with a past medical history notable only for a prior cesarean section, received an uneventful laparoscopic repair of a ventral hernia. Post-operatively, she received morphine analgesia by a patient controlled analgesia (PCA) pump. After developing an unanticipated stupor, her morphine was discontinued. She received several doses of naloxone without response. A computerized tomography (CT) of the head demonstrated no acute changes. With an arterial pCO2 value of 62 mm Hg, she was placed on biphasic positive airway pressure (BiPAP) ventilation. She remained somnolent. A formalized evaluation of her delirium included a thyroid function panel and random cortisol level, both studies demonstrated abnormally low values. A magnetic resonance image (MRI) of her brain revealed a partially empty sella turcica. Her normal luteinizing hormone (LH) and folliclestimulating hormone (FSH) levels were discordant with her post-menopausal status, and her prolactin level was below the normal reference range. After receiving thyroxine and hydrocortisone replacement therapy, her depressed consciousness resolved within two days. Upon a later interview, she revealed that 22-years prior she had a cesarean delivery of her seventh child, resulting in a large blood loss and subsequent hypotension. Unlike her six previous pregnancies, she failed lactation after delivery, and subsequently never resumed menstruation. DISCUSSION: Sheehan's syndrome is an obstetric complication that occurs with excessive blood loss and ischemic shock following a complicated delivery. This results in an infarction of the pituitary's anterior lobe. As a result of her hypopituitarism, this patient developed secondary thyroid and adrenal failure as well as gonadal insufficiency. With an unrecognized secondary hypothyroidism, the exaggerated depressant effects of her analgesics resulted in a postoperative stupor. Careful attention to hypothyroidism should be noted with any patient who develops an excessive central nervous system response to anesthetics or analgesics.