A 35-year-old mother of two children is suffering from amenorrhea from last 12 month. She has a history of failure of lactation following second delivery but remained asymptomatic thereafter. Skull X-ray shows empty sella diagnosis is:
Ans. is c, i.e. Sheehan's syndromeRef: Williams Gynae 1st/ed, p374; Leon Speroff 7th/ed, p438; Jeffcoate 7th/ed, p582-583Here before arriving to any diagnosis lets first see the causes of:Empty Sella:* Congenital incompleteness of the sellar diaphragm.* Secondary to surgery/radiotherapy or infarction of pituitary tumor.* Secondary to infarction and necrosis of pituitary gland.Now from the given causes: either pituitary tumor or Sheehan's syndrome can cause an empty sella on X-ray.Pituitary tumours (micro/macroadenoma) are prolactin secreting tumors and hence, cause galactorrhea (not lactational failure) with amenorrhea and are so, ruled out.So, the obvious answer by exclusion is Sheehan's Syndrome.Sheehan's syndrome:* It is the syndrome which results from ischemic necrosis of most of the anterior pituitaryQ due to spasm in its arterioles occurring at the time of severe hemorrhage or shock, complicating childbirth.Clinical Features: SymptomsQ* Failure of lactation after deliveryQ* Secondary amenorrheaQ* Loss of libidoQ* Increased sensitivity to cold (hvpothyroidism)Q Remember | Amenorrhea With failure to lactate With galactorrhea, headache and blurring of vision| |Think sheehan's syndrome Think prolactinoma
Menopause
Pituitary tumor
Sheehan's syndrome
Intraductal papilloma of breast
Disorders in Menstruation