A woman who had a massive postpartum hemorrhage with hypovolemic shock during her last delivery returns six months later. She reports inability to breastfeed her current infant despite wanting to, persistent fatigue, cold intolerance, and absence of menses since delivery. Examination reveals loss of axillary and pubic hair. The most likely diagnosis is:

• A Asherman syndrome
• B Sheehan syndrome ✓
• C Postpartum thyroiditis
• D Premature ovarian insufficiency

Explanation

Postpartum pituitary necrosis follows severe PPH with shock. The earliest and most characteristic manifestation is failure of lactation from prolactin deficiency, followed later by amenorrhea, loss of secondary sexual hair, and features of evolving thyroid and adrenal insufficiency. Asherman syndrome causes amenorrhea but spares lactation and hair, since it is an endometrial adhesion problem. Premature ovarian insufficiency would raise gonadotropins and would not explain failed lactation.

Reference: Williams Obstetrics, 25th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.