Pregnancy complicated by multiple pituitary hormone deficiencies

Abstract

We report a case of pituitary dwarfism and diabetes insipidus due to pituitary stalk transection in a pregnant Japanese woman, 138 cm in height, born by breech delivery with no evidence of ante- or intrapartum asphyxia. The patient had no central nervous disturbance, was diagnosed with pituitary dwarfism during childhood and was treated at another hospital with growth hormone supplement from 5 to 14 years of age. This patient was referred to our department at 17 weeks' gestation due to a change of residence. At 30 weeks' gestation, she was hospitalized for assessment of hydronephrosis and polyuria (15-20 L/day). Analysis of a 24-h urine sample showed creatinine clearance of 157 mL/min and urine osmolality of 38 mOsm/L. The patient's urine output decreased after receiving a test dose of 0.75 g of 1-desamino-8-D-arginine vasopressin (DDAVP). Cranial magnetic resonance imaging showed transection of the pituitary stalk. Subsequently, the patient's urine output was well controlled by a maintenance dose of 0.275 mL/day intranasal DDAVP. A cesarean section was performed at 37 weeks, as the patient height was 138 cm, and a pelvic X-ray showed cephalopelvic disproportion. She delivered a female baby weighing 2302 g, and both 1- and 5-min Apgar scores were 9. The patient was followed up after 4 months and showed no visual deterioration or polyuria while on DDAVP therapy, while the neonate grew favorably.

Nephrogenic Diabetes Insipidus or Bartter Syndrome? A Dilemma of Refractory Hypokalemia in Pregnancy: A Case Report from Soedono Regional Public Hospital in Madiun

“…The exclusion of organic diseases is crucial for a DI diagnosis. 3 In our case, the patient also presented with refractory hypokalemia, prompting an investigation for other conditions or syndromes similar to DI, which may indicate an underlying organic disease.…”

Case of pituitary stalk transection syndrome ascertained after breech delivery

“…15 The mechanism responsible for pituitary stalk transection syndrome is still unknown. Although there have been many reports that have suggested that endocrinopathy and transection of the pituitary stalk may have an association with breech delivery, [3][4][5][6][7][8][9][10][11] Triulzi et al reported that only 32% of a study population of 101 patients had a birth history of breech delivery. They concluded that dysgenesis of the mediobasal prosencephalic structures or brain anomaly probably caused endocrinopathy, and that breech delivery may be the result of a midline brain anomaly, rather than the cause.…”