A 28-year-old woman presents with secondary amenorrhoea for 8 months, low FSH, low LH, low oestrogen, and MRI shows an empty sella. Which of the following conditions most likely explains this combination?
- A Sheehan's syndrome with hypopituitary hypogonadotropic hypogonadism ✓
- B Premature ovarian insufficiency (POI)
- C Polycystic ovary syndrome
- D Turner syndrome (45,X)
Correct answer: A. Sheehan's syndrome with hypopituitary hypogonadotropic hypogonadism
Explanation
Empty sella syndrome following postpartum pituitary necrosis (Sheehan's syndrome) presents with low FSH/LH (hypogonadotropic hypogonadism) due to anterior pituitary destruction. The MRI finding of an empty or partially empty sella confirms the diagnosis. POI presents with elevated FSH/LH (hypergonadotropic hypogonadism). PCOS features elevated LH and normal-high oestrogen. Turner syndrome, a cause of primary amenorrhoea with hypergonadotropic hypogonadism, would show elevated FSH/LH not low.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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