Spontaneous Pregnancy and Partial Recovery of Pituitary Function in a Patient with Sheehan's Syndrome

See, Ting Ting; Lee, Siu Pak; Chen, Hua Fen

doi:10.1016/s1726-4901(09)70247-3

Cited by 25 publications

(12 citation statements)

References 4 publications

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“…[24–26] Similarly, partial recovery of pituitary function has also been reported. [27] Hyponatremia is the most common electrolyte disturbance occurring in 33–69% of all cases. Several mechanisms are responsible for hyponatremia.…”

Section: Anterior Pituitary Dysfunctionmentioning

confidence: 99%

Sheehan′s syndrome: Newer advances

Shivaprasad¹

2011

Indian J Endocr Metab

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Sheehan's syndrome (SS) is postpartum hypopituitarism caused by necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery. Patients with SS have varying degrees of anterior pituitary hormone deficiency. Its frequency is decreasing worldwide and it is a rare cause of hypopituitarism in developed countries owing to advances in obstetric care. However, it is still frequent in underdeveloped and developing countries. SS often evolves slowly and hence is diagnosed late. History of postpartum hemorrhage, failure to lactate and cessation of menses are important clues to the diagnosis. Early diagnosis and appropriate treatment are important to reduce morbidity and mortality of the patients.

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Section: Anterior Pituitary Dysfunctionmentioning

confidence: 99%

Sheehan′s syndrome: Newer advances

Shivaprasad¹

2011

Indian J Endocr Metab

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“…There was only 1 single case reported partial recovery of hypothalamus-pituitary-thyroid (HPT) axis of a patient with Sheehan's Syndrome in the previous study. 9 In our case, the patient's HPA axis was blunted after the pituitary macroadenoma surgery. Before her pregnancy, the peak value of serum cortisol in the insulin tolerance test was 11.05 μg/dl; however, after the delivery, the serum cortisol showed a well response to the insulin tolerance test (Figure 2 ).…”

Section: Discussionmentioning

confidence: 51%

“…Spontaneous pregnancy in patients with pituitary dysfunction were only reported in partial hypopituitarism patients with normal gonadal function, most commonly in Sheehan's syndrome or lymphocytic hypohysitis. 9 , 10 Panhypopituitarism patients could not be spontaneous pregnant, clinical practice of ovulation–induction treatment including administration of hCG and follicle-stimulating hormone, pulsatile GnRH, and in vitro fertilization, enabled the hypopituitary women to become ovulation and pregnancy. However, limited experience showed that the success rate was less lower than other no ovulation infertility.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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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.

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“…So pregnancy is propitious to the patients with Sheehan's syndrome, but it could improve the symptoms as well. See et al [15] reported that spontaneous pregnancy could bring partial recovery of pituitary function in the patient with Sheehan's syndrome. However, in this case, the symptoms of Sheehan's syndrome got worse after the fourth spontaneous pregnancy.…”

Section: Discussionmentioning

confidence: 99%

The Symptoms Get Worse after Pregnancy in Sheehan's Syndrome: A Case Report

Hao

Zhang

2012

Case Reports in Medicine

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Sheehan's syndrome, which is pituitary necrosis after severe postpartum hemorrhage and hypovolemia, may cause hypopituitarism immediately or several years later, depending on the degree of tissue destruction. We report an unusual case, in which a 55-year-old woman with Sheehan's syndrome got worse symptoms after spontaneous labor. In 1998, she had severe postpartum hemorrhage and pituitary necrosis during the third delivery, thus it was diagnosed as Sheehan's syndrome by clinical manifestations, laboratory tests, and magnetic resonance imaging. She was treated by replacement therapy including hydrocortisone and levothyroxine sodium. However, she had the fourth spontaneous pregnancy in 2000 and got worse symptoms after delivery. We carefully concluded that pregnancy provided no evidence against the diagnosis of Sheehan's syndrome because pregnancy might improve hypopituitarism by stimulating the pituitary remnant to undergo hyperplasia and irritating the placenta to secrete hormone. However, pregnancy might aggravate the symptoms by inducing autoimmunity as well. All in all, early diagnosis and adequate medical treatment are important to provide a good prognosis of Sheehan's syndrome.

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Spontaneous Pregnancy and Partial Recovery of Pituitary Function in a Patient with Sheehan's Syndrome

Cited by 25 publications

References 4 publications

Sheehan′s syndrome: Newer advances

Sheehan′s syndrome: Newer advances

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

The Symptoms Get Worse after Pregnancy in Sheehan's Syndrome: A Case Report

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