Endocrine: Sheehan syndrome: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Endocrine: Sheehan syndrome

Sample item

A 28-year-old woman had severe postpartum haemorrhage with hypotension. She later cannot breastfeed, has amenorrhoea, fatigue and cold intolerance. What is the underlying pathology?

AA functioning prolactin-secreting adenomaBIschaemic necrosis of the enlarged anterior pituitaryCCompression of the pituitary stalk by a craniopharyngiomaDAutoimmune lymphocytic destruction of the adrenal cortex

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Ischaemic necrosis of the enlarged anterior pituitary

In pregnancy the anterior pituitary enlarges through lactotroph hyperplasia without a matching increase in blood supply, and the portal circulation is vulnerable to hypotension. Haemorrhage causes infarction and panhypopituitarism, called Sheehan syndrome, with early failure of lactation. Replacement of cortisol, thyroxine and sex steroids is needed.

Option by option

A. A functioning prolactin-secreting adenoma
A prolactinoma causes galactorrhoea and amenorrhoea, not failed lactation.
B. Ischaemic necrosis of the enlarged anterior pituitary (correct)
Correct. Infarction of the pregnancy-enlarged pituitary explains the pituitary hormone loss after haemorrhage.
C. Compression of the pituitary stalk by a craniopharyngioma
A craniopharyngioma produces hypopituitarism by compression, usually in children with calcified suprasellar masses, without a link to haemorrhage.
D. Autoimmune lymphocytic destruction of the adrenal cortex
Adrenal autoimmune destruction would cause Addison disease with hyperpigmentation and would not impair lactation.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Ischaemic necrosis of the enlarged anterior pituitary. In pregnancy the anterior pituitary enlarges through lactotroph hyperplasia without a matching increase in blood supply, and the portal circulation is vulnerable to hypotension.

Why is "A functioning prolactin-secreting adenoma" not the answer?

A prolactinoma causes galactorrhoea and amenorrhoea, not failed lactation.

Why is "Compression of the pituitary stalk by a craniopharyngioma" not the answer?

A craniopharyngioma produces hypopituitarism by compression, usually in children with calcified suprasellar masses, without a link to haemorrhage.

Why is "Autoimmune lymphocytic destruction of the adrenal cortex" not the answer?

Adrenal autoimmune destruction would cause Addison disease with hyperpigmentation and would not impair lactation.

What concept does this question test?

It tests Endocrine: Sheehan syndrome in Pathology. Haemorrhage causes infarction and panhypopituitarism, called Sheehan syndrome, with early failure of lactation. Replacement of cortisol, thyroxine and sex steroids is needed.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrine: Sheehan syndrome?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.