A 28-year-old woman has secondary amenorrhea for 8 months after a complicated delivery with postpartum hemorrhage requiring transfusion. She reports failure of lactation, fatigue, and weight loss. Serum cortisol at 8 AM is 3.2 mcg/dL (normal >10). Which is the most likely diagnosis?
- A Hashimoto thyroiditis
- B Sheehan syndrome ✓
- C Primary adrenal insufficiency
- D Prolactinoma
Correct answer: B. Sheehan syndrome
Explanation
Sheehan syndrome is pituitary necrosis from postpartum hemorrhage causing panhypopituitarism. It presents with failure of lactation, amenorrhea, and signs of pituitary hormone deficiency (low cortisol, hypothyroidism, low gonadotropins). Prolactinoma would raise prolactin. Primary adrenal insufficiency would have elevated ACTH. Hashimoto thyroiditis does not explain the cortisol deficiency.
Reference: Williams Endocrinology, 14th ed.
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