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Sheehan syndrome — SCE Endocrinology MCQ

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ModeratePituitarySheehan syndromeSCE Endocrinology

A 33-year-old woman has fatigue 8 months after severe postpartum haemorrhage requiring transfusion. She could not breastfeed and has not resumed menses. Sodium is 130 mmol/L, free T4 is low with inappropriately normal TSH, and 09:00 cortisol is 90 nmol/L. What is the most likely diagnosis?

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Correct answer: B — Sheehan syndrome

Failure to lactate, amenorrhoea and multiple anterior pituitary hormone deficiencies after major postpartum haemorrhage are typical of Sheehan syndrome. Postpartum thyroiditis would not explain low cortisol and gonadotrophin failure. The pearl is to replace cortisol before thyroid hormone.

Reference: Society for Endocrinology hypopituitarism guidance