A 27-year-old woman delivered her second child at home with massive postpartum haemorrhage requiring transfusion. She failed to lactate afterwards and has had no menses for 14 months. She reports fatigue and loss of pubic hair. Which investigation best confirms the cause of her amenorrhoea?
- A Normal FSH with intrauterine adhesions on hysteroscopy
- B Elevated serum FSH with low estradiol
- C Low serum FSH, LH and estradiol with normal prolactin response excluded ✓
- D Elevated serum prolactin with galactorrhoea
Correct answer: C. Low serum FSH, LH and estradiol with normal prolactin response excluded
Explanation
Postpartum pituitary necrosis (Sheehan syndrome) follows obstetric haemorrhage and hypotension. The earliest affected cells are lactotrophs, so failure of lactation is the classic first sign, followed by loss of gonadotrophin secretion causing hypo-oestrogenic amenorrhoea with low FSH and LH. Elevated FSH would indicate ovarian failure, intrauterine adhesions indicate Asherman syndrome, and hyperprolactinaemia contradicts the lactation failure that defines this presentation.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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