A 29-year-old woman develops secondary amenorrhoea after a delivery complicated by massive postpartum haemorrhage requiring transfusion. She fails to lactate postpartum and now reports fatigue and loss of pubic and axillary hair. Which hormonal profile is expected?

• A High FSH, high LH, low estradiol
• B Low FSH, low LH, low estradiol ✓
• C Normal FSH, high LH, high estradiol
• D Low FSH, high LH, normal estradiol

Explanation

Postpartum pituitary necrosis (Sheehan syndrome) causes panhypopituitarism. The failing lactation reflects loss of prolactin, and loss of pubic and axillary hair reflects adrenal androgen decline from absent ACTH drive. Gonadotropins are low, not elevated, which distinguishes this hypogonadotropic hypogonadism from ovarian failure, where FSH and LH are both high with low estradiol.

Reference: Williams Obstetrics, 26th ed.

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