A woman who had massive postpartum hemorrhage with shock after her last delivery now presents with secondary amenorrhea. She failed to lactate after that delivery and has loss of axillary and pubic hair. Which investigation best confirms the diagnosis?
- A Serum prolactin response to TRH stimulation
- B Basal FSH, LH, TSH, cortisol and prolactin panel showing multiple hormonal deficiencies ✓
- C Dynamic pituitary MRI with gadolinium
- D Progesterone challenge test
Correct answer: B. Basal FSH, LH, TSH, cortisol and prolactin panel showing multiple hormonal deficiencies
Explanation
Sheehan syndrome is postpartum pituitary necrosis following obstetric hemorrhage; the earliest and classic clue is failure of lactation from prolactin deficiency, followed by amenorrhea from gonadotropin loss. Diagnosis rests on demonstrating deficient basal pituitary hormones (FSH, LH, TSH, ACTH axis, prolactin) with low target gland hormones. MRI may show an empty sella later but is not the primary diagnostic tool and can be normal. A progesterone challenge only assesses estrogen sufficiency and cannot distinguish hypothalamic from pituitary causes.
Reference: Williams Gynecology, 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.