This page is dedicated to organizing various examples of standardized exam questions whose answer is Sheehan syndrome. While this may seem a odd practice, it is useful to see multiple examples of how Sheehan syndrome will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for Sheehan syndrome.
- Significant blood loss during recent pregnancy:
- Excessive bleeding during/after delivery
- Hypotension for extended periods of time
- Transfusion may be required during/after delivery
- Symptoms after the pregnancy:
- Failure to lactate
- Cold intolearnace
Question # 1
A 37 year old woman comes to the clinic for the evaluation of fatigue. She explains that she has been very tired for the past 4 months since the birth of her twins. She has not been able to keep track of all the new responsibilities the she has, and even forgets to eat “all the time”. She is disappointed because she is unable to breastfeed, despite having going to meet with a lactation consultant on a number of occasions. The patient had a vaginal delivery that was complicated by uterine atony, as well as bleeding (requiring multiple transfusions). She has a past history of depression that was treated with an antidepressant. This was discontinued (against medical advice) when she became pregnant. Her last menstrual period was before her last pregnancy. Her BMI is 18.0 kg/m². Blood pressure is 84/50 mm Hg, and pulse is 65/min. Her physical exam shows a thin, tired woman. Her hemoglobin is 10.0 g/dL. What is the most likely cause of this patient’s symptoms?
Explanation # 1
Question # 2
Explanation # 2
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
- Cause: ischemic damage to the anterior pituitary during pregnancy (secondary to excessive blood loss)
- Consequence: the anterior pituitary will no longer release its hormones leading to various issues:
- Decreased TSH: fatigue cold intolerance, slowed deep-tendon reflexes
- Decreased Prolactin: inability to lactate
- Decreased ACTH: hypotension, weight loss, hypoglycemia
- Decreased FSH/LH:
Page Updated: 10.15.2016