A 29-year-old woman who delivered her first child 14 months ago presents with failure of lactation immediately after delivery and absence of menstruation since. The delivery was complicated by massive postpartum haemorrhage requiring transfusion. Serum FSH 2 IU/L, LH 1.8 IU/L, prolactin 3 ng/mL, TSH 0.9 mIU/L with low free T4. What is the most likely diagnosis?

• A Asherman syndrome
• B Sheehan syndrome (postpartum pituitary necrosis) ✓
• C Premature ovarian insufficiency
• D Prolactin-secreting pituitary microadenoma

Explanation

Postpartum haemorrhage with shock causes ischaemic necrosis of the enlarged pituitary, producing panhypopituitarism. Failure of lactation from absent prolactin is the earliest clue, followed by low gonadotropins causing amenorrhoea. Asherman syndrome gives normal gonadotropins and prolactin with a normal endometrium response pattern, and premature ovarian insufficiency shows high FSH, so both are excluded by this panhypopituitary profile.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.