A woman who had a postpartum hemorrhage requiring 4 units of blood transfusion returns 3 months later complaining of inability to breastfeed, fatigue, and loss of axillary and pubic hair. Serum prolactin is undetectable and she fails to lactate despite suckling. The most likely diagnosis is:

• A Asherman syndrome
• B Autoimmune lymphocytic hypophysitis
• C Sheehan syndrome ✓
• D Prolactin-secreting pituitary microadenoma

Explanation

Sheehan syndrome is postpartum pituitary necrosis caused by severe peripartum hemorrhage and hypotension, which produces ischemic infarction of the enlarged pregnant pituitary. Failure of lactation from absent prolactin is the earliest and most characteristic clue, followed later by loss of pubic and axillary hair, amenorrhea, and progressive panhypopituitarism. Asherman syndrome causes amenorrhea from intrauterine adhesions but does not abolish 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.