Snapshot A 27-year-old, 2-week post-partum woman presents to the clinic complaining of weakness, fatigue, and inability to produce milk. Her pregnancy was unremarkable but she suffered significant blood loss during delivery. She reports that the first few days she was producing enough milk for her baby but the supply subsequently decreased. Laboratory testing demonstrates low serum cortisol and plasma ACTH levels. (Sheehan syndrome) Introduction A disorder characterized by decreased secretion of corticotropin (ACTH) by the pituitary gland leading to adrenal insufficiency (e.g., low levels of cortisol). login to view 1 more bullet Epidemiology Risk factors login to view 3 more bullets ETIOLOGY Pathogenesis login to view 8 more bullets Presentation Symptoms login to view 7 more bullets Physical exam login to view 3 more bullets imaging Computed tomography (CT) of the brain login to view 3 more bullets Magnetic resonance imaging (MRI) of the brain login to view 1 more bullet Studies Serum labs login to view 11 more bullets Diagnostic Laboratory Values for Secondary Adrenal Insufficiency Test Result Cortisol Low (5 ug/dL) ACTH Low (<5 pg/mL) ACTH stimulation test Normal CRH stimulation test Normal Differential Primary adrenal insufficiency login to view 3 more bullets Tertiary adrenal insufficiency login to view 2 more bullets DIAGNOSIS Diagnosis is often based on clinical presentation and confirmed via laboratory testing Imaging studies used to determine the cause of secondary adrenal insufficiency Treatment Treatment overview login to view 2 more bullets Pharmacologic login to view 3 more bullets Complications Adrenal crisis login to view 1 more bullet