questions 3

Sheehan Syndrome

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Topic updated on 11/19/16 3:54am

Snapshot
  • 26-year-old woman, 5 days post vaginal delivery, presents to their pediatrician with a complaint that she is unable to breast feed her child. History reveals a vaginal delivery complicated by postpartum hemorrhage.
Introduction
  • Failure to lacatate following postpartum hemorrhage  
    • result of pituitary infarction that occured as a result of hypovolemic shock
      • pituitary normally very enlarged during pregancy due ↑ lactotrophs
      • no corresponding ↑ blood supply
    • hypopituitarism results in ↓ prolactin secretion
Presentation
  •  Symptoms  
    • sudden cessation of lactation 
      • loss of prolactin
    • fatigue
      • loss of TSH
    • loss of pubic and axillary hair
      • loss of LH/FSH
    • anorexia
Evaluation
  • Only clinically significant cause of lower than normal serum prolactin levels


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Qbank (2 Questions)

TAG
(M1.EC.40) Four months after giving birth, a young woman presents to the hospital complaining of lack of breast milk secretion. The patient complains of constantly feeling tired. Physical exam reveals that she is slightly hypotensive and has lost a significant amount of weight since giving birth. The patient states that she has not experienced menstruation since the birth. Which of the following is likely to have contributed to this patient's presentation? Topic Review Topic

1. Obstetric hemorrage
2. Prolactinoma
3. Pregnancy-induced decrease in anterior pituitary size
4. Primary empty sella syndrome
5. Increased anterior pituitary perfusion

PREFERRED RESPONSE ▶
TAG
(M1.EC.4707) A 32-year-old female presents to her obstetrician 3 weeks postpartum for failure to lactate. Of note, she has been unable to tolerate cold environments since the birth of her child. Review of systems is positive for fatigue, lightheadedness, and a 3-pound weight gain over the last 3 weeks. Her delivery was complicated by placenta accreta with postpartum blood loss. Her newborn infant is doing well on formula. She denies any personal or family history of thyroid disease. Physical exam is overall unremarkable. On a panel of hormone testing, which of the following levels is most likely to be normal in this patient? Topic Review Topic

1. Antidiuretic hormone
2. Aldosterone
3. Cortisol
4. Luteinizing hormone
5. Thyroid hormone

PREFERRED RESPONSE ▶
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