Recovery of HPA Axis Function After Successful Gonadotropin-Induced Pregnancy and Delivery in a Woman With Panhypopituitarism

Abstract

Hypopituitarism is defined as the partial or complete defect of anterior pituitary hormone secretion. Patients with hypopituitarism usually need life-long hormone replacement therapy. However, in this case, we report a patient with panhypopituitarism whose hypothalamus–pituitary–adrenal (HPA) axis function was completely recovered after pregnancy and delivery.In this case study, we reported the case management and conducted a review of literature to identify the possible mechanism of pituitary function recovery.The patient who suffered from secondary amenorrhea was found a nonfunctioning pituitary macroadenoma, and the hormone test showed serum cortisol, FT3, FT4, thyrotropic hormone, and prolactin were at normal range. After surgical removal of the tumor which invasion in the sellar region, the patient had panhypopituitarism confirmed by the routine hormone test. Though spontaneous pregnancy is impossible in female patients with panhypopituitarism, the patient was restored fertility by the help of artificial reproductive techniques. After the confirmation of the pregnancy, levothyroixine was increased to 75 μg daily and readjusted to 150 μg daily before delivery according to the monthly measurement thyroid function. Hydrocortisone 10 mg daily replaced cortisone acetate; the dose was increased according to the symptoms of morning sickness. A single stress dose of hydrocortisone (200 mg) was used before elective cesarean delivery and was tapered to the dose of 10 mg per day in 1 week. Levothyroixine was reduced to 75 μg daily after delivery. During follow-up, her hypothalamus–pituitary–adrenal (HPA) axis function was completely recovered. The peak serum cotisol level could increase to 19.08 μg/dL by insulin-induced hypoglycemia. However, growth hormone remained unresponsive to the insulin-tolerance test, and thyroid hormone still needed exogenous supplementation.Hormone replacement therapy needed closely followed by endocrinologist and multidisciplinary cooperation during the pregnancy of patients with hypopituitarism. This case indicates that the pituitary function may partially recover after pregnancy in panhypopituitarism patients.

Successful pregnancy and delivery in a female with pituitary stalk interruption syndrome following in vitro fertilization and embryo transfer: A case report and literature review

“…We conducted a literature search and found that successful pregnancies and deliveries have been reported in several cases of female panhypopituitarism patients over the past few decades. Surgical removal of pituitary macroadenoma, 12 corticotropic adenoma, 13 and suprasellar germinoma 14 are the main causes of panhypopituitarism, while successful pregnancies and deliveries, either spontaneously or by assisted reproduction, have not yet been reported in female PSIS patients. A population‐based study on pregnancy outcomes in women with panhypopituitarism revealed a higher risk of maternal infection and congenital anomalies in these women.…”

Successful pregnancy and delivery in a Chinese female with pituitary stalk interruption syndrome following in vitro fertilization and embryo transfer: a case report and literature review

“…We searched the literature and found that several cases of successful pregnancies and deliveries were reported in panhypopituitarism female patients in the past few decades. Panhypopituitarism was mainly caused by surgical removal of pituitary macroadenoma [15], corticotropic adenoma[16], and suprasellar germinoma [17], while successful pregnancies and deliveries either spontaneously or by assisted reproduction were still not found in PSIS female patients. The results of a population-based study on pregnancy outcomes in women with panhypopituitarism showed that the risk of maternal infection and congenital anomalies was higher in women affected by panhypopituitarism, and no signi cant differences were found in the risk of developing gestational hypertension, gestational diabetes mellitus, placental abruption, preterm delivery, small for gestational age or other pregnancy complications [18].…”

Twin Pregnancy in Woman with Panhypopituitarism:Case Report and Mini Review of Literature

“…We selected 17 papers that met the objectives of our research and the exclusion criteria (Figure 1). In all case reports in the literature, except that of I. Lata [11], pregnancy has occurred thanks to techniques of ARTs [13][14][15][17][18][19][20][21][22][23][24][25][26][27][28][29] (Table 1). However, success rate was lower than in other unovulatory infertility.…”