A 27-year-old woman who delivered her first baby six months ago after a massive postpartum haemorrhage reports inability to breastfeed, loss of axillary and pubic hair, fatigue, and cold intolerance. Her blood pressure is 92/60 mmHg. Which single finding would most strongly support the suspected diagnosis?
- A Elevated TSH with low free T4
- B Low cortisol with low ACTH and low prolactin, FSH, LH and IGF-1 ✓
- C Elevated prolactin with galactorrhoea
- D Hypernatraemia with dilute urine
Correct answer: B. Low cortisol with low ACTH and low prolactin, FSH, LH and IGF-1
Explanation
Sheehan syndrome is postpartum pituitary necrosis following obstetric haemorrhage, causing panhypopituitarism. The signature pattern is simultaneous deficiency of all anterior pituitary hormones, so cortisol, ACTH, prolactin, gonadotrophins and IGF-1 are all low, explaining failed lactation and loss of secondary sexual hair. Primary hypothyroidism raises TSH, whereas central hypothyroidism here gives a low or inappropriately normal TSH, killing option A. Hypernatraemia suggests diabetes insipidus, which is uncommon in Sheehan syndrome.
Reference: Williams Textbook of Endocrinology, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.