Successful Pregnancies After Adequate Hormonal Replacement in Patients With Combined Pituitary Hormone Deficiencies

Correa, Fernanda A.; Bianchi, Pedro Kastein Faria da Cunha; França, Marcela M.; Otto, Aline P.; Rodrigues, Rodrigo J M; Ejzenberg, Dani; Serafini, P.; Baracat, Edmund C.; Francisco, Rossana Pulcineli Vieira; Brito, Vinícius Nahime; Arnhold, Ivo J.P.; Mendonça, Berenice Bilharinho; Carvalho, Luciani R.

doi:10.1210/js.2017-00005

Cited by 19 publications

(20 citation statements)

References 26 publications

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“…FSH and LH or their equivalent (recombinant forms) are administered by injections and are necessary for fertility. Reduced fertility outcomes in the context of ovulation per cycle or achievement of live-birth have been reported in some [78], but not in all studies [79].…”

Section: Central Hypogonadism In Femalesmentioning

confidence: 99%

Management of Hypopituitarism

Alexandraki

Grossman

2019

JCM

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Hypopituitarism includes all clinical conditions that result in partial or complete failure of the anterior and posterior lobe of the pituitary gland’s ability to secrete hormones. The aim of management is usually to replace the target-hormone of hypothalamo-pituitary-endocrine gland axis with the exceptions of secondary hypogonadism when fertility is required, and growth hormone deficiency (GHD), and to safely minimise both symptoms and clinical signs. Adrenocorticotropic hormone deficiency replacement is best performed with the immediate-release oral glucocorticoid hydrocortisone (HC) in 2–3 divided doses. However, novel once-daily modified-release HC targets a more physiological exposure of glucocorticoids. GHD is treated currently with daily subcutaneous GH, but current research is focusing on the development of once-weekly administration of recombinant GH. Hypogonadism is targeted with testosterone replacement in men and on estrogen replacement therapy in women; when fertility is wanted, replacement targets secondary or tertiary levels of hormonal settings. Thyroid-stimulating hormone replacement therapy follows the rules of primary thyroid gland failure with L-thyroxine replacement. Central diabetes insipidus is nowadays replaced by desmopressin. Certain clinical scenarios may have to be promptly managed to avoid short-term or long-term sequelae such as pregnancy in patients with hypopituitarism, pituitary apoplexy, adrenal crisis, and pituitary metastases.

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Section: Central Hypogonadism In Femalesmentioning

confidence: 99%

Management of Hypopituitarism

Alexandraki

Grossman

2019

JCM

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“…Women and girls with parasellar lesions are at risk of infertility because of the potential detrimental effects of surgery and radiotherapy on the hypothalamic-pituitary axis. Retrospective studies report pregnancy rates of between 47 and 76% amongst women with hypopituitarism [86][87][88][89][90]. In childhood, both hypopituitarism and isolated HH may lead to smaller uterine dimensions and ovarian volume compared with healthy controls [91].…”

Section: Female Infertilitymentioning

confidence: 99%

“…COS protocols for assisted reproduction in women with HH are described in Table 3. The reported pregnancy rates after COS amongst HH women vary wildly, from 19.4 to 100%, with a 3.6-41.7% risk of multiple pregnancies [88][89][90][95][96][97][98][99][100]. Higher gonadotropin doses are generally used than in patients with other causes of infertility [101].…”

Section: Female Infertilitymentioning

confidence: 99%

Late Effects of Parasellar Lesion Treatment: Hypogonadism and Infertility

et al. 2020

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Central hypogonadism, also defined as hypogonadotropic hypogonadism, is a recognized complication of hypothalamic-pituitary-gonadal axis damage following treatment of sellar and parasellar masses. In addition to radiotherapy and surgery, CTLA4-blocking antibodies and alkylating agents such as temozolomide can also lead to hypogonadism, through different mechanisms. Central hypogonadism in boys and girls may lead to pubertal delay or arrest, impairing full development of the genitalia and secondary sexual characteristics. Alternatively, cranial irradiation or ectopic hormone production may instead cause early puberty, affecting hypothalamic control of the gonadostat. Given the reproductive risks, discussion of fertility preservation options and referral to reproductive specialists before treatment is essential. Steroid hormone replacement can interfere with other replacement therapies and may require specific dose adjustments. Adequate gonadotropin stimulation therapy may enable patients to restore gametogenesis and conceive spontaneously. When assisted reproductive technology is needed , protocols must be tailored to account for possible long-term gonadotropin insufficiency prior to stimulation. The aim of this review was to provide an overview of the risk factors for hypogonadism and infertility in patients treated for parasellar lesions and to give a summary of the current recommendations for management and follow-up of these dysfunctions in such patients. We have also briefly summarized evidence on the physiological role of pituitary hormones during pregnancy, focusing on the management of pituitary deficiencies.

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“…In a different model of childhood onset CHPD, Correa reports on five cases from a single center. Pregnancy has been obtained in all cases with controlled ovarian stimulation and GH –LT4 co-treatment (17).…”

Section: Evidence From “Human Models”mentioning

confidence: 99%

Growth Hormone and Reproduction: Lessons Learned From Animal Models and Clinical Trials

et al. 2019

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Growth Hormone (GH) has been considered as a therapeutic option to increase the number of growing follicles during Assisted Reproductive Technology (ART) for more than 30 years. In this review the biological rationale for therapeutic GH usage is explained through evidence in animal models, aiming to put this into a clinical context. First, we explain the GH—Insulin like Growth Factor (IGF)-1—gonadal axis and its role in reproduction. Evidence suggests that GH can stimulate the secretion of IGF1 not only in the liver but also in the peripheral target structures, including the ovary. Moreover, IGF-1 can be secreted locally under the influence of stimuli other than GH. In the case of the ovary, steroid hormones, gonadotropins or the combination of both seems to be involved. Even more interesting, the ovary itself can secret GH locally and exert a paracrine action modulating the intracellular signaling pathway of GH, i.e., not by the systemic pathway where GH binds to the extracellular domain of the GH receptor. Finally, these aspects from animal models are put into clinical perspective by discussing results and shortcomings of studies and meta-analyses in order to put forth the state-of-the-art rationale for therapeutic GH usage in modern ART.

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Successful Pregnancies After Adequate Hormonal Replacement in Patients With Combined Pituitary Hormone Deficiencies

Cited by 19 publications

References 26 publications

Management of Hypopituitarism

Management of Hypopituitarism

Late Effects of Parasellar Lesion Treatment: Hypogonadism and Infertility

Growth Hormone and Reproduction: Lessons Learned From Animal Models and Clinical Trials

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