{"id":1793,"date":"2022-08-31T13:04:00","date_gmt":"2022-08-31T13:04:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=1793"},"modified":"2025-10-01T11:40:31","modified_gmt":"2025-10-01T19:40:31","slug":"usmle-step-1-question-of-the-day-sheehan-syndrome","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-sheehan-syndrome","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Sheehan Syndrome"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-sheehan-syndrome\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-sheehan-syndrome\/#D_Necrosis_of_the_anterior_pituitary_gland\" >D. Necrosis of the anterior pituitary gland<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-sheehan-syndrome\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-sheehan-syndrome\/#A_Infarction_of_the_hypothalamus\" >A. Infarction of the hypothalamus<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-sheehan-syndrome\/#B_Lymphocytic_infiltration_of_the_thyroid_gland\" >B. Lymphocytic infiltration of the thyroid gland<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-sheehan-syndrome\/#C_Lymphocytic_infiltration_of_the_pituitary_gland\" >C. Lymphocytic infiltration of the pituitary gland<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-sheehan-syndrome\/#E_Proliferation_of_lactotroph_cells\" >E. Proliferation of lactotroph cells<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-sheehan-syndrome\/#F_Postpartum_thyroiditis\" >F. Postpartum thyroiditis<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-sheehan-syndrome\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-sheehan-syndrome\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-sheehan-syndrome\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.<\/em><\/strong><strong><em>&nbsp;Today&#8217;s case involves a 34-year-old woman with an inability to breastfeed her baby.&nbsp;<\/em><\/strong><strong><em>Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 34-year-old woman, gravida 1 para 1, comes to the clinic due to an inability to breastfeed her baby. She had a spontaneous vaginal delivery of a healthy newborn at full-term 3 weeks ago. The labor was complicated by&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Postpartum_hemorrhage\" target=\"_blank\" rel=\"noreferrer noopener\">postpartum hemorrhage<\/a>&nbsp;secondary to retained products of conception, and she required transfusion with 3 units of packed red blood cells. She has been using formula for feeding, as her milk never \u201ccame in.\u201d Review of systems is significant for increased fatigue over the same period, which she attributes to lack of sleep. Temperature is 36.5\u00b0C (97\u00b07 F), pulse is 102\/min, and blood pressure is 92\/76 mm Hg. Physical examination reveals cool, dry skin. Which of the following is the most likely cause of this patient\u2019s condition?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Infarction of the hypothalamus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Lymphocytic infiltration of the thyroid gland<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Lymphocytic infiltration of the pituitary gland<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Necrosis of the anterior pituitary gland<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Proliferation of lactotroph cells<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>F. Postpartum thyroiditis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down to find the answer!<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Everybody loves Osmosis.org\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/kizbJZ9cdLg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><u><em><strong>\u2192 Reinforce your understanding with more self-assessment items on Osmosis<\/strong><\/em><\/u>,<\/a><\/em><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Necrosis_of_the_anterior_pituitary_gland\"><\/span>D. Necrosis of the anterior pituitary gland<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The incorrect answers to today&#8217;s USMLE\u00ae Step 1 Question are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Infarction_of_the_hypothalamus\"><\/span>A. Infarction of the hypothalamus<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Infarction of the hypothalamus is a possible cause of<a href=\"https:\/\/www.osmosis.org\/learn\/Hypopituitarism\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;hypopituitarism<\/a>. However, it is rare, as postpartum hemorrhage commonly affects the hyperplastic pituitary gland.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Lymphocytic_infiltration_of_the_thyroid_gland\"><\/span>B. Lymphocytic infiltration of the thyroid gland<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>The characteristic histopathological finding in&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hashimoto_thyroiditis\" target=\"_blank\" rel=\"noreferrer noopener\">Hashimoto thyroiditis<\/a>&nbsp;is profuse lymphocytic infiltration of the thyroid, along with destruction of thyroid follicles. While these patients may also present with signs of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hypothyroidism\" target=\"_blank\" rel=\"noreferrer noopener\">hypothyroidism<\/a>&nbsp;(e.g., fatigue, cool dry skin), this diagnosis does not adequately explain this patient\u2019s inability to lactate and abnormal vitals.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Lymphocytic_infiltration_of_the_pituitary_gland\"><\/span>C. Lymphocytic infiltration of the pituitary gland<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Lymphocytic hypophysitis is characterized by lymphocytic infiltration and destruction of pituitary cells. Although this may also present as&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hypopituitarism\" target=\"_blank\" rel=\"noreferrer noopener\">hypopituitarism<\/a>&nbsp;during late pregnancy or the postpartum period, this patient\u2019s postpartum hemorrhage followed by panhypopituitarism is suggestive of a different diagnosis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Proliferation_of_lactotroph_cells\"><\/span>E. Proliferation of lactotroph cells<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Lactotrophs are cells in the anterior pituitary gland which produce prolactin. Proliferation of these cells results in&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Prolactinoma\" target=\"_blank\" rel=\"noreferrer noopener\">prolactinoma<\/a>, and its growth can cause compression of nearby cells, resulting in decreased secretion of other anterior pituitary hormones. This diagnosis is an unlikely cause of this patient\u2019s condition, who is presenting with failure of lactation.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"F_Postpartum_thyroiditis\"><\/span>F. Postpartum thyroiditis<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Postpartum_thyroiditis\" target=\"_blank\" rel=\"noreferrer noopener\">Postpartum thyroiditis<\/a>&nbsp;is an autoimmune-mediated destructive thyroiditis within 1 year of parturition that results in the classic signs and symptoms of hypothyroidism (e.g., fatigue, constipation, cold intolerance). Although this patient is presenting with signs and symptoms of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hypothyroidism\" target=\"_blank\" rel=\"noreferrer noopener\">hypothyroidism<\/a>, she has additional features (e.g., failure to lactate, abnormal vital signs) that can not be explained by hypothyroidism alone.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T070628.514.png\" alt=\"The Ultimate Guide to the USMLE Step 1: Everything you need to know\" class=\"wp-image-1795\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T070628.514.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T070628.514.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient\u2019s clinical presentation is concerning for&nbsp;<strong>panhypopituitarism<\/strong>&nbsp;(given the fatigue, sleep disturbances, inability to lactate, hypotension and cold, dry skin). Given her history of severe peripartum blood loss, the diagnosis of&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Sheehan_syndrome\" target=\"_blank\" rel=\"noreferrer noopener\">Sheehan syndrome<\/a><\/strong>&nbsp;is most likely. likely.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"605\" height=\"631\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T070742.410.png\" alt=\"Panhypopituitarism table with hormones and their clinical manifestations.\" class=\"wp-image-1796\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T070742.410.png 605w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T070742.410.png?resize=288,300 288w\" sizes=\"auto, (max-width: 605px) 100vw, 605px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Ischemia and necrosis<\/strong>&nbsp;of the&nbsp;<strong>anterior pituitary<\/strong>&nbsp;is the underlying mechanism for&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Sheehan_syndrome\" target=\"_blank\" rel=\"noreferrer noopener\">Sheehan syndrome<\/a><\/strong>. During pregnancy, increased circulating&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Estrogen_and_progesterone\" target=\"_blank\" rel=\"noreferrer noopener\">estrogen&nbsp;<\/a>causes hyperplasia of lactotrophs in order to prepare for the increased hormonal demands during and following pregnancy. This increased size of the pituitary, however, is not associated with increased blood flow, which makes the pituitary gland especially susceptible to&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Ischemia\" target=\"_blank\" rel=\"noreferrer noopener\">ischemia&nbsp;<\/a>during&nbsp;<strong>low-volume states<\/strong>&nbsp;(e.g. prolonged or severe postpartum bleeding).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The onset of clinical features of the ensuing&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Hypopituitarism\" target=\"_blank\" rel=\"noreferrer noopener\">hypopituitarism<\/a><\/strong>&nbsp;is dependent on the severity of blood loss and can occur any time from the immediate postpartum period to years after delivery. Severe cases usually present as&nbsp;<strong>failure to lactate<\/strong>,&nbsp;<strong>fatigue<\/strong>, and&nbsp;<strong>lethargy<\/strong>&nbsp;within the first days or weeks after delivery. All pituitary hormonal deficiencies can occur, but the sudden onset of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Adrenocorticotropic_hormone\" target=\"_blank\" rel=\"noreferrer noopener\">ACTH<\/a>&nbsp;(and therefore,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Cortisol\" target=\"_blank\" rel=\"noreferrer noopener\">cortisol<\/a>) deficiency is the most serious because it can cause life-threatening hypotension.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Diagnosis is clinical. Although&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Oxytocin_and_prolactin\" target=\"_blank\" rel=\"noreferrer noopener\">prolactin&nbsp;<\/a>levels are usually not measured, the basal levels of the other pituitary hormones are necessary. Treatment consists of&nbsp;<strong>lifelong hormone substitution therapy<\/strong>&nbsp;for each individual hormone that is deficient. deficient.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"605\" height=\"326\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T070816.673.png\" alt=\"Sheehan syndrome suspected when prolactin deficiency and hypopituitarism present.\" class=\"wp-image-1797\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T070816.673.png 605w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T070816.673.png?resize=300,162 300w\" sizes=\"auto, (max-width: 605px) 100vw, 605px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><a href=\"https:\/\/www.osmosis.org\/learn\/Sheehan_syndrome\" target=\"_blank\" rel=\"noreferrer noopener\">Sheehan syndrome<\/a><\/strong>&nbsp;is a result of&nbsp;<strong>ischemia and necrosis<\/strong>&nbsp;of pituitary gland that can occur in an event of profound peripartum blood loss. It clinically presents with signs and symptoms of&nbsp;<strong>panhypopituitarism<\/strong>, such as&nbsp;<strong>inability to lactate<\/strong>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Amenorrhea\" target=\"_blank\" rel=\"noreferrer noopener\">amenorrhea<\/a>, lethargy, fatigue and signs and symptoms of other pituitary hormone deficiencies.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span><strong>References<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Snyder PJ. Causes of hypopituitarism. Cooper, DS, ed. UpToDate. Waltham, MA: UpToDate Inc.&nbsp;<a href=\"https:\/\/www.uptodate.com\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.uptodate.com<\/a>&nbsp;(Accessed on December 9th, 2019.)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>_________________________<\/strong><br><br><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis today! Access your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/login?type=create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T070843.618.png\" alt=\"Osmosis sign up ad\" class=\"wp-image-1800\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T070843.618.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T070843.618.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.&nbsp;<\/sub><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case involves a 34-year-old woman with an inability to breastfeed her baby.&nbsp;Can you figure it out? A 34-year-old woman, gravida 1 para 1, comes to the clinic due to an inability to breastfeed her baby. She had [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":1794,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,1369,44],"tags":[],"class_list":["post-1793","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-1-questions","category-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Sheehan Syndrome - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-sheehan-syndrome\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Sheehan Syndrome - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case involves a 34-year-old woman with an inability to breastfeed her baby.&nbsp;Can you figure it out? A 34-year-old woman, gravida 1 para 1, comes to the clinic due to an inability to breastfeed her baby. 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