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Sheehan's syndrome — SCE Endocrinology MCQ

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HardPituitarySheehan's syndromeSCE Endocrinology

A 31-year-old woman has fatigue and recurrent collapses 5 months after postpartum haemorrhage requiring transfusion. She cannot lactate and has amenorrhoea. Sodium is 130 mmol/L, free T4 is low with normal TSH, and cortisol is 94 nmol/L. What is the most likely diagnosis?

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Correct answer: E — Sheehan's syndrome

Sheehan's syndrome is best because failure to lactate plus multiple anterior pituitary hormone deficiencies after severe postpartum haemorrhage is typical of Sheehan's syndrome. The alternatives are less appropriate because postpartum thyroiditis does not explain ACTH deficiency; Addison's disease is primary adrenal; PCOS does not cause low cortisol; phaeochromocytoma causes catecholamine episodes. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: Society for Endocrinology hypopituitarism guidance