Three months after a delivery complicated by massive postpartum haemorrhage requiring transfusion, a 29-year-old woman reports inability to breastfeed, persistent fatigue, cold intolerance, and loss of pubic and axillary hair. Cortisol response to ACTH stimulation is blunted, LH and FSH are low, and prolactin is undetectable. What is the most likely diagnosis?

• A Lymphocytic hypophysitis
• B Sheehan syndrome ✓
• C Empty sella syndrome
• D Prolactin-secreting microadenoma with stalk compression

Explanation

Pituitary infarction after obstetric haemorrhage causes Sheehan syndrome, whose earliest clue is failure of lactation from absent prolactin, followed by loss of axillary and pubic hair, amenorrhoea, and secondary adrenal and thyroid failure. Lymphocytic hypophysitis also occurs around pregnancy but typically presents with headache, mass effect, and hyperprolactinaemia rather than panhypopituitarism after haemorrhage. Empty sella is usually asymptomatic and discovered incidentally.

Reference: Williams Textbook of Endocrinology, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.