A 24-year-old primigravida had a home delivery complicated by massive postpartum hemorrhage and hypovolemic shock requiring referral transfusion. Six weeks later she reports inability to breastfeed, profound fatigue, cold intolerance, and loss of pubic and axillary hair. The most likely diagnosis is:
- A Asherman syndrome
- B Simmonds cachexia due to anorexia nervosa
- C Sheehan syndrome ✓
- D Lymphocytic hypophysitis
Correct answer: C. Sheehan syndrome
Explanation
The gravid pituitary enlarges and its low-pressure portal supply makes it vulnerable to ischemic necrosis during severe obstetric hemorrhage and shock. Postpartum failure of lactation is the earliest clue, followed by features of evolving panhypopituitarism such as lethargy, cold intolerance, and loss of axillary and pubic hair. Asherman syndrome causes amenorrhea from intrauterine adhesions but spares lactation, which distinguishes it here.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.