A 27-year-old woman who delivered 3 weeks ago after massive postpartum haemorrhage reports inability to breastfeed, profound fatigue, and cold intolerance. Sodium is 126 mEq/L, free T4 is low, cortisol at 8 AM is 3 microg/dL, LH and FSH are undetectable. What is the most likely diagnosis?
- A Sheehan syndrome ✓
- B Lymphocytic hypophysitis
- C Empty sella syndrome
- D Subacute granulomatous thyroiditis
Correct answer: A. Sheehan syndrome
Explanation
Postpartum pituitary necrosis from obstetric haemorrhage produces panhypopituitarism, classically heralded by failure of lactation because of prolactin deficiency. Low anterior pituitary hormones with secondary target gland failure confirm the diagnosis. Lymphocytic hypophysitis also occurs postpartum but typically presents with headache, visual field defects, and a mass effect rather than isolated failure of lactation. Empty sella is usually asymptomatic with preserved function.
Reference: Williams Textbook of Endocrinology, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.