A 30-year-old woman G3P2 presents six months after a home delivery complicated by massive postpartum haemorrhage. She reports inability to breastfeed since delivery, persistent fatigue, cold intolerance, and loss of axillary and pubic hair. Her serum sodium is 128 mEq/L. The most likely diagnosis is:
- A Hashimoto thyroiditis
- B Lymphocytic hypophysitis
- C Sheehan syndrome ✓
- D Prolactinoma
Correct answer: C. Sheehan syndrome
Explanation
Postpartum pituitary necrosis follows severe obstetric haemorrhage and hypotension; the enlarged pregnant pituitary is vulnerable to ischaemia. Failure of lactation from loss of prolactin is typically the earliest sign, followed by features of evolving panhypopituitarism including hyponatraemia and loss of secondary sexual hair. Hashimoto thyroiditis does not explain agalactorrhoea linked temporally to the haemorrhage, and lymphocytic hypophysitis usually presents during pregnancy itself.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.