Snap Shot 5 days post-vaginal delivery, a 26-year-old woman presents to her pediatrician with the inability to breast feed her child. History reveals that her vaginal delivery was complicated by a postpartum hemomorhage. Introduction Postpartum hemmorhage-induced infarction of the pituitary gland result of hypovolemic shock pituitary normally very enlarged during pregancy due increased lactotrophs there is no corresponding increase in blood supply to the pituitary gland and can infarct when systemic blood pressure drops hypopituitarism results in reduced prolactin secretion Mecahism Presentation Symptoms sudden cessation of lactation or failure to commence 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 Imaging MR shows infarction of the pituitary gland