How does Sheehan's syndrome primarily manifest?

Sheehan's syndrome primarily manifests due to hypopituitarism secondary to blood loss during and after childbirth. This condition occurs when the pituitary gland, which is crucial for hormone regulation, does not receive enough blood supply following severe hemorrhage during or after delivery. As a result, the lack of oxygen and nutrients leads to the death of pituitary cells, causing a decrease in the production of various hormones such as cortisol, thyroid hormones, and reproductive hormones.

The clinical implications of this include symptoms that stem from the deficiencies in these hormones, such as fatigue, inability to breastfeed (due to low prolactin), low blood pressure, and others related to the specific hormonal deficiencies that arise from pituitary failure.

The other choices relate to different conditions or manifestations that are not the primary cause of Sheehan's syndrome. Increased ACTH levels generally indicate adrenal insufficiency or other conditions affecting the adrenal glands, while primary adrenal insufficiency focuses on the adrenal gland itself rather than the pituitary. Excessive cortisol release suggests a different scenario, often seen in conditions like Cushing's syndrome, which is unrelated to Sheehan's syndrome. Thus, the correct understanding of the manifestation of Sheehan's syndrome lies in recognizing its association