A 28-year-old woman delivered vaginally 3 weeks ago with an episode of major postpartum haemorrhage requiring transfusion. She reports she has been unable to express any breast milk since delivery despite frequent suckling, along with profound fatigue and loss of axillary and pubic hair. The most likely diagnosis is:

• A Lymphocytic hypophysitis
• B Postpartum thyroiditis
• C Prolactinoma with apoplexy
• D Sheehan syndrome ✓

Explanation

Sheehan syndrome is postpartum pituitary necrosis following obstetric haemorrhage and hypovolemic shock. The earliest and most characteristic clue is failure of lactation because prolactin secretion is lost first, followed by failure of resumption of menses and other anterior pituitary deficits. The history of major PPH with inability to lactate and loss of secondary sexual hair makes lymphocytic hypophysitis and thyroiditis unlikely, since neither links temporally to haemorrhage.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.