Snapshot A 26-year-old woman, 5 days post vaginal delivery, presents to her child's 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 lactate 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