Carmen has just given birth to her third child, and as with the first two, she stayed home and used the services of a nurse-midwife. While her recovery from the births of the first two children was normal and she was able to breast-feed both for two years, she is not lactating this time and is experiencing other difficulties. Her symptoms also include vomiting, fatigue, cold intolerance, and

Question

myxedema, which worsen over the coming weeks. She ignored her midwife's suggestion to see her doctor the day after giving birth, but has finally gone to an Ob-Gyn during the third week postpartum. Her newborn baby is healthy and thriving on human breast milk purchased from a milk bank. Diagnostic tests indicate decreased amounts of several hormones, as well as edema and poor blood flow into the pituitary. What do her symptoms indicate? Which hormones are likely decreased? What may be the root cause?

What will be an ideal response?

Answer 1

A lack of several pituitary hormones is apparent: PRH stimulates prolactin secretion and lactation, vomiting and
fatigue could indicate lack of ACTH and consequent cortisol, and cold intolerance and myxedema indicate lack of
TSH and consequent thyroid hormone. Abnormal function of the anterior pituitary can result from lack of
hypothalamic-releasing hormones, pituitary adenoma, or pituitary infarction related to pregnancy (Sheehan
syndrome; this syndrome is not described in the text, but the student may be able to reason decreased pituitary
function due to decreased blood flow).