A 29-year-old woman who had massive postpartum haemorrhage requiring transfusion presents 8 weeks later unable to breastfeed, with fatigue, loss of pubic and axillary hair, and persistent amenorrhoea. Serum prolactin is undetectable. Which pattern of pituitary hormone loss best explains her presentation?

• A Isolated ACTH deficiency
• B Isolated gonadotrophin deficiency
• C Selective GH and prolactin deficiency with evolving panhypopituitarism ✓
• D Elevated prolactin suppressing GnRH pulsatility

Explanation

Sheehan syndrome results from postpartum pituitary necrosis after obstetric haemorrhage. Lactotrophs hypertrophy greatly in pregnancy and are among the earliest affected, so failure of lactation with an undetectable prolactin is the classic presenting sign, often accompanied by growth hormone deficiency. Gonadotroph failure follows with amenorrhoea and loss of secondary sexual hair, while ACTH and TSH deficits may appear later. Suppressed, not elevated, prolactin distinguishes this from a prolactinoma, and isolated single-axis losses do not fit the diffuse injury.

Reference: Williams Textbook of Endocrinology, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.