A 27-year-old woman had a home delivery complicated by massive postpartum hemorrhage requiring referral and transfusion. Three weeks later she reports she has been unable to express any breast milk since delivery, feels profoundly fatigued, and has not resumed urination frequency issues. Her blood pressure is 90/60 mmHg. What is the most likely diagnosis?

• A Asherman syndrome
• B Lymphocytic hypophysitis
• C Postpartum thyroiditis
• D Sheehan syndrome ✓

Explanation

Sheehan syndrome is pituitary necrosis following obstetric hemorrhage and shock. The lateral wings of the anterior pituitary are perfused last by the portal circulation, so somatotroph and lactotroph function fail first, making failure of lactation the earliest and most reliable clue. Asherman syndrome causes amenorrhea through intrauterine adhesions but does not impair lactation, which kills that distractor.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.