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Self-Assessment Questions

Obstetrics & Gynecology

Answer 4
  1. A patient with severe postpartum hemorrhage. Pituitary insufficiency secondary to ischemia and infarction, which appear as late sequelae to obstetric hemorrhage, is known as Sheehan’s syndrome. The volume of the anterior pituitary increases during pregnancy by approximately one third, resulting in an upward convexity of the superior surface on radiography. The hypertrophied pituitary gland of pregnant women is very susceptible to a compromised blood supply through the low pressure sinusoidal system that accompanies postpartum hemorrhage. Classically, patients with Sheehan’s syndrome present with rapid breast involution and failure to lactate, resume menses, or regrow shaved pubic or axillary hair. Bleeding that is not related to obstetrics does not cause pituitary ischemia and infarction.

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