A 32-year-old woman has a complicated delivery with severe postpartum hemorrhage requiring transfusion. Six months later, she presents with failure of lactation, fatigue, and amenorrhea. Pituitary MRI shows an empty sella. The underlying mechanism of her hypopituitarism is:

• A Autoimmune destruction of anterior pituitary
• B Pituitary apoplexy
• C Hypothalamic dysfunction
• D Ischemic necrosis of the enlarged anterior pituitary ✓

Explanation

Sheehan syndrome results from ischemic necrosis of the anterior pituitary following postpartum hemorrhage. During pregnancy, lactotroph hyperplasia enlarges the anterior pituitary, increasing its metabolic demand. The anterior pituitary depends on the hypophyseal portal system for blood supply, making it vulnerable to hypotension. The posterior pituitary, with its direct arterial supply, is typically spared.

Reference: Williams Textbook of Endocrinology, 14th ed.

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Written and medically reviewed by the StethoPrep medical team.