A 26-year-old woman who had a massive postpartum hemorrhage during her first home delivery returns 3 months later complaining of inability to breastfeed, persistent amenorrhoea, fatigue, and loss of axillary and pubic hair. Serum prolactin is low and she fails to respond to TRH stimulation. The most likely diagnosis is:

• A Asherman syndrome
• B Sheehan syndrome ✓
• C Simmonds cachexia
• D Autoimmune hypophysitis

Explanation

Postpartum pituitary necrosis follows severe obstetric hemorrhage and hypovolemic shock; the enlarged pregnant pituitary is vulnerable to ischemia. Failure of lactation from prolactin deficiency is usually the earliest sign, followed later by loss of other anterior pituitary axes. Asherman syndrome causes amenorrhoea but preserves lactation and pituitary function. Autoimmune hypophysitis is not linked to hemorrhage, and Simmonds cachexia refers to panhypopituitary wasting from any cause.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.