A 35-year-old woman is seen 6 months after giving birth to a normal infant. She suffered severe cervical lacerations during delivery, resulting in hemorrhagic shock. Following blood transfusion and surgical repair, postpartum recovery has so far been uneventful. She now complains of continued amenorrhea and loss of weight and muscle strength. Further investigation might be expected to demonstrate which of the following findings?
- Decreased serum cortisol
- Hyperestrinism
- Hyperglycemia
- Increased hair growth in a male distribution pattern
- Increased serum free thyroxine
The history is strongly suggestive of panhypopituitarism due to ischemic necrosis of the pituitary, occurring as a sequela to childbirth complicated by hemorrhagic shock (Sheehan syndrome). This syndrome is clinically dominated by overt evidence of gonadotropin and corticotropin deficiencies, along with laboratory evidence of these deficiencies and thyrotropin deficiency. Overt secondary hypothyroidism sometimes occurs.
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