A 32-year-old woman had massive postpartum hemorrhage with hypotension requiring multiple transfusions during her last delivery two years ago. Since then she has failed to lactate, has lost axillary and pubic hair, and has persistent amenorrhea without hot flushes. Which pituitary hormone deficit appeared first and best explains her inability to breastfeed?

• A Prolactin ✓
• B TSH
• C ACTH
• D Gonadotropins (FSH and LH)

Explanation

This is Sheehan syndrome, postpartum pituitary necrosis following obstetric hemorrhage. The anterior pituitary is affected in order of vulnerability, and prolactin is among the earliest hormones lost, so failure of lactation is often the first clinical clue. Amenorrhea follows gonadotropin loss. The absence of hot flushes despite low estrogen reflects concurrent loss of FSH and LH rather than ovarian failure, distinguishing it from premature menopause.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.