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Snapshot
  • 26-year-old woman, 5 days post vaginal delivery, presents to their pediatrician with a complaint that she is unable to breast feed her child. History reveals a vaginal delivery complicated by postpartum hemorrhage.
Introduction
  • Failure to lacatate following postpartum hemorrhage  
    • result of pituitary infarction that occured as a result of hypovolemic shock
      • pituitary normally very enlarged during pregancy due ↑ lactotrophs
      • no corresponding ↑ blood supply
    • hypopituitarism results in ↓ prolactin secretion
Presentation
  •  Symptoms  
    • sudden cessation of lactation 
      • loss of prolactin
    • fatigue
      • loss of TSH
    • loss of pubic and axillary hair
      • loss of LH/FSH
    • anorexia
Evaluation
  • Only clinically significant cause of lower than normal serum prolactin levels
 

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