Differential Diagnosis for a 38-year-old Woman with Fatigue and Amenorrhea
- Single most likely diagnosis:
- Postpartum depression with possible underlying postpartum thyroiditis or anemia: The patient's history of major depressive disorder, recent childbirth, difficulty with breastfeeding, and current symptoms of fatigue, loss of appetite, and amenorrhea are highly suggestive of postpartum depression. The addition of anemia (Hemoglobin 10.1 g/dL) and the physical examination findings support this diagnosis, as anemia can contribute to fatigue. Postpartum thyroiditis could also be a contributing factor, given its association with postpartum depression and fatigue.
- Other Likely diagnoses:
- Iron deficiency anemia: Given the patient's low hemoglobin level and history of multiple blood transfusions due to a retained placenta, iron deficiency anemia is a plausible diagnosis contributing to her fatigue.
- Hypopituitarism (Sheehan syndrome): Although less common, the patient's history of a complicated delivery with significant blood loss and the need for multiple blood transfusions increases the risk for hypopituitarism, which could explain her amenorrhea and fatigue.
- Postpartum thyroiditis: This condition can cause fatigue, amenorrhea, and mood changes, making it a possible contributor to the patient's symptoms.
- Do Not Miss diagnoses:
- Puerperal infection or sepsis: Although the patient is 5 months postpartum, a chronic infection could still be present, especially given her history of a retained placenta and dilation and curettage. Infection could lead to sepsis, a life-threatening condition.
- Hemorrhage or significant blood loss: The patient's history of a retained placenta and low blood pressure (80/50 mm Hg) suggests the possibility of ongoing or recurrent blood loss, which is a medical emergency.
- Rare diagnoses:
- Lymphocytic hypophysitis: A rare condition that can cause hypopituitarism, leading to symptoms similar to those the patient is experiencing. It is often associated with pregnancy.
- Other endocrine disorders (e.g., adrenal insufficiency): These could also explain the patient's fatigue, low blood pressure, and amenorrhea, although they are less likely given the context of her recent pregnancy and postpartum period.