A 29-year-old woman who delivered at home with massive postpartum hemorrhage fails to lactate, then develops amenorrhea, loss of pubic and axillary hair, cold intolerance, and hypotension over the following months. MRI shows a partially empty sella. The underlying lesion is:

• A Autoimmune lymphocytic hypophysitis
• B Ischemic necrosis of the anterior pituitary ✓
• C Granulomatous infiltration by sarcoidosis
• D Hemorrhagic infarction of a pre-existing macroadenoma

Explanation

Sheehan syndrome is postpartum ischemic necrosis of the anterior pituitary. The enlarged pregnant gland is vulnerable because its blood supply comes from low-pressure portal vessels, and severe obstetric hemorrhage causes vasospasm and thrombosis. Failure of lactation reflects loss of prolactin first, followed by progressive panhypopituitarism. Lymphocytic hypophysitis occurs during pregnancy or postpartum but is inflammatory rather than hemorrhagic, and apoplexy implies a pre-existing adenoma.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.