A 27-year-old woman who had massive postpartum hemorrhage after her first delivery presents 4 months later complaining that she never produced breast milk. She also reports fatigue, cold intolerance, and loss of pubic and axillary hair. The single best initial investigation to confirm the suspected diagnosis is:

• A Serum prolactin level
• B MRI of the sella turcica
• C Serum electrolytes and random blood glucose
• D Basal hormonal profile including cortisol, TSH, FSH and LH ✓

Explanation

The picture is Sheehan syndrome, postpartum pituitary necrosis following obstetric hemorrhage. Failure of lactation is the earliest clue because prolactin secretion fails first. Confirmation rests on demonstrating low basal levels of anterior pituitary target hormones (cortisol, thyroid hormones, gonadotropins) before imaging. MRI may show an empty sella later but does not establish functional deficiency, and isolated prolactin cannot assess panhypopituitarism.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.