A woman who delivered after a massive postpartum haemorrhage from placenta praevia reports she never produced breast milk despite frequent suckling. Which endocrine finding explains this as the earliest manifestation of her condition?

• A Oxytocin deficiency preventing milk synthesis
• B Loss of growth hormone secretion causing poor glandular development
• C Elevated dopamine suppressing the let-down reflex
• D Loss of prolactin secretion due to anterior pituitary ischaemic necrosis ✓

Explanation

Sheehan syndrome results from ischaemic necrosis of the enlarged postpartum pituitary after obstetric haemorrhage. Failure of lactation is the earliest clinical clue because milk production depends immediately on prolactin, whose secretion is lost early. Growth hormone and thyroid or adrenal deficits appear later, and secondary amenorrhoea follows loss of gonadotropins over subsequent weeks. Oxytocin governs milk ejection, not synthesis, so option A misattributes the physiology.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.