Postpartum thyroiditis and hypothalamo-hypophysial insufficiency in the same woman with successive pregnancies: a case report

Objective The aim of the study is to assess the distinguishing features of pregnancy-related hypophysitis (PR-Hy) compared to non-pregnancy autoimmune hypophysitis and to evaluate the changing therapeutic approaches and outcome in PR-Hy over time. Design Retrospective analysis of all published cases with PR-Hy and six own cases. Methods A PubMed search was performed and abstracts screened for publications with information on cases with PR-Hy from which full-text review was performed. Clinical features, diagnostic findings, and outcome in relation to treatment modalities in PR-Hy were assessed. Results One hundred and forty eight cases with PR-Hy were identified. PR-Hy was significantly delimited from non-PR-Hy by frequent occurrence of chiasmal syndrome (50% vs 13%, P < 0.0001), higher rate of intrasellar origin (94% vs 74%, P = 0.0005), lower rate of pituitary stalk involvement (39% vs 86%, P < 0.0001), and low rate of diabetes insipidus (12% vs 54%, P < 0.0001). The role of surgery in PR-Hy decreased over time while noninvasive treatment modalities increased. The recurrence rate after high-dose glucocorticoid therapy (36%) was high and exceeded that of surgery (2%) and conservative management (3%). In contrast to initial reports on PR-Hy, recent literature regarding outcome of mother’s and child’s health was positive. The frequency of spontaneous preterm delivery was not increased. Recurrent PR-Hy in a subsequent pregnancy was reported in only 2 females. Conclusion PR-Hy has distinct features that delineate the disorder from non-PR-Hy. With increasing experience in diagnosis, availability of adequate replacement therapy, and improved treatment modalities, PR-Hy has lost its threat and the outcome is encouraging.

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Current World Literature

2011

Current Opinion in Rheumatology

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Postpartum thyroiditis and hypothalamo-hypophysial insufficiency in the same woman with successive pregnancies: a case report

Abstract: This case signals role of autoimmune mechanisms underlying the endocrinopathies seen after successive pregnancies of the same patient.

Cited by 5 publications

References 19 publications

The First Case of Association Between Postpartum Thyroiditis and Thyroid Hormone Resistance in an Italian Patient Showing a Novel p.V283A THRB Mutation

The First Case of Association Between Postpartum Thyroiditis and Thyroid Hormone Resistance in an Italian Patient Showing a Novel p.V283A THRB Mutation

Pregnancy-related hypophysitis revisited

Current World Literature

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