A 29-year-old woman delivered vaginally 8 months ago with a massive postpartum haemorrhage requiring transfusion. Lactation never established. Since then she has had no menses, profound fatigue, cold intolerance, and progressive loss of pubic and axillary hair. Her BMI is 19. Serum prolactin, FSH, LH, TSH, and cortisol response are all low. What is the underlying lesion?

• A Intrauterine synechiae obliterating the endometrial cavity
• B Prolactin-secreting pituitary microadenoma with stalk effect
• C Ischaemic necrosis of the anterior pituitary ✓
• D Empty sella syndrome with cerebrospinal fluid herniation

Explanation

Postpartum haemorrhage with shock causes Sheehan syndrome: ischaemic necrosis of the blood-supply-dependent hypertrophied anterior pituitary. Failure of lactation (no prolactin), followed by loss of all anterior pituitary axes including adrenal and thyroid function, is the classic sequence. Asherman syndrome gives amenorrhoea with normal hormones and preserved lactation, and it cannot explain panhypopituitarism. Empty sella is usually asymptomatic and unrelated to obstetric haemorrhage.

Reference: DC Dutta's Textbook of Obstetrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.