<prompt> A 35-year-old mother of two children is suffering from amenorrhea from last 12 month. She has a history of failure of lactation following second delivery but remained asymptomatic thereafter. Skull X-ray shows empty sella diagnosis is:MenopausePituitary tumorSheehans syndromeIntraductal papilloma of breast  <response>: Ans. is c, i.e. Sheehans syndromeRef: Williams Gynae 1sted, p374; Leon Speroff 7thed, p438; Jeffcoate 7thed, p582-583Here before arriving to any diagnosis lets first see the causes of:Empty Sella: Congenital incompleteness of the sellar diaphragm. Secondary to surgeryradiotherapy or infarction of pituitary tumor. Secondary to infarction and necrosis of pituitary gland.Now from the given causes: either pituitary tumor or Sheehans syndrome can cause an empty sella on X-ray.Pituitary tumours micromacroadenoma are prolactin secreting tumors and hence, cause galactorrhea not lactational failure with amenorrhea and are so, ruled out.So, the obvious answer by exclusion is Sheehans Syndrome.Sheehans syndrome: It is the syndrome which results from ischemic necrosis of most of the anterior pituitaryQ due to spasm in its arterioles occurring at the time of severe hemorrhage or shock, complicating childbirth.Clinical Features: SymptomsQ Failure of lactation after deliveryQ Secondary amenorrheaQ Loss of libidoQ Increased sensitivity to cold hvpothyroidismQ Remember Amenorrhea With failure to lactate With galactorrhea, headache and blurring of vision Think sheehans syndrome Think prolactinoma 