Successful Pregnancies and Deliveries in a Patient With Evolving Hypopituitarism due to Pituitary Stalk Transection Syndrome: Role of Growth Hormone Replacement

Yoshizawa, Miyako; Ieki, Yasuhiko; Takazakura, Eisuke; Fukuta, Kaori; Hidaka, Takao; Wakasugi, Takanobu; Shimatsu, Akira

doi:10.2169/internalmedicine.56.7478

Cited by 8 publications

(5 citation statements)

References 12 publications

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“…When comparing ovarian stimulation cycles with or without GHRT adjunction, opposite results were found. Some authors found beneficial effects of GHRT such as reduction of total human menopausal gonadotropins (hMG) dose used (21), more mono-follicular recruitment (10), shorter duration of stimulation before pregnancy (22), better embryo quality and higher fertilization rate in intracytoplasmic sperm injection or in vitro fecondation (IVF), without modification of the number of harvested oocytes (23,24), while others did not find any difference (25,26). The only randomized crossover study, by Blumenfeld, evaluated seven GHD infertile women requiring ovarian stimulation or ART and found a beneficial effect of GHRT (21).…”

Section: Introductionmentioning

confidence: 99%

Normal-high IGF-1 level improves pregnancy rate after ovarian stimulation in women treated with growth hormone replacement therapy

Dubreuil

Touraine

2022

Endocrine Connections

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Objective: Growth hormone (GH) and insulin-like growth factors (IGFs) are not mandatory for reproductive life, but data suggest their synergistic action with follicle stimulating hormone (FSH) throughout ovarian folliculogenesis. We aimed to evaluate the association of IGF-I level on clinical pregnancy rate after ovarian stimulation, with or without intra-uterine insemination, in women with GH deficiency treated with GH replacement therapy at conception. Design and Methods: Data from 19 women with both GH deficiency and hypogonadotropic hypogonadism referred to our reproductive medicine department, were retrospectively collected. IGF-I levels were assessed in a single laboratory, values were expressed in standard deviations (SD) from the mean. Results: Amongst the 7 patients receiving GH replacement therapy during ovarian stimulation, higher IGF-I level was significantly associated with clinical pregnancy (+0.4 SD vs -1.6 SD, p=0.03). Amongst the 24 pregnancies obtained by the 19 infertile patients, pregnancy loss was less frequent with the addition of GH replacement therapy, than without (1 miscarriage out of 8 total pregnancies, vs 4 miscarriages out of 16 total pregnancies). Conclusions: This is the first study evaluating the association of IGF-I level on clinical pregnancy rate, in GH-treated women at conception. When taking care of female infertility due to hypogonadotropic hypogonadism, practitioners should enquire about associated GH deficiency and IGF-I level. To ensure higher clinical pregnancy chances, practitioners should aim for IGF-I values at conception ranging from 0 SD to +2 SD, and if necessary, could discuss initiation or increase GH treatment. Prospective studies should help strengthen our results.

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Section: Introductionmentioning

confidence: 99%

Normal-high IGF-1 level improves pregnancy rate after ovarian stimulation in women treated with growth hormone replacement therapy

Dubreuil

Touraine

2022

Endocrine Connections

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“…However, the safety of growth hormone supplementation during pregnancy is still unclear, due to the unknown maternal and fetal side effects. To address this concern, we reviewed the literature 5,6 and decided to reduce the dosage of growth hormone to 0.3 mg (1 IU) daily from the gestation of 8 weeks until the end of the second trimester (gestation of 26 weeks) and then discontinue the supplement. Levothyroxine doses were increased to 125 μg daily from 100 μg daily, and prednisone was exchanged for hydrocortisone with a dosage of 10 mg daily after 8 weeks of gestation until delivery.…”

Section: Case Presentationmentioning

confidence: 99%

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

Zhang,

Liu,

Zhou

et al. 2023

Intl J Gynecology & Obste

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Pituitary stalk interruption syndrome (PSIS) in female patients is mainly characterized by short stature, primary amenorrhea, absent or incomplete sexual maturation, and infertility. Successful pregnancies among these patients are rare. In this report, we describe a successful pregnancy and delivery in a 28‐year‐old Chinese woman with PSIS following in vitro fertilization and embryo transfer. The patient exhibited typical symptoms, including multiple pituitary hormone deficiency, typical triad signs in magnetic resonance imaging (MRI), undetectable serum gonadotropins and estradiol levels, and invisible antral follicles in both ovaries. During the first attempted controlled ovarian hyperstimulation cycle, 14 oocytes were retrieved and six embryos were acquired. Artificial endometrial preparation and frozen–thawed embryo transfer were performed, resulting in a clinical pregnancy after the transfer of a day 5 blastocyst. The patient was closely monitored throughout the pregnancy and multiple hormone dosages were modulated accordingly. She delivered a healthy boy by elective cesarean section, and the newborn developed normally during a 1‐year follow‐up period. This is the first report of a successful live birth in a woman with PSIS achieved through in vitro fertilization and frozen–thawed embryo transfer. A literature review on this topic is also presented.

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“…Whether growth hormone supplementation should be continued during pregnancy remains unclear because of the unidenti ed maternal and fetal side effects of growth hormone supplementation. We reviewed the literature [5][6][7] and decided to reduce the dosage of growth hormone to 0.3 mg (1 IU) daily, in view of the lack of su cient safety data during pregnancy, from the gestation of 8 weeks until the end of the second trimester (gestation of 26 weeks) to discontinue the supplement. Levothyroxine doses were increased to 125 µg daily from 100 µg daily, and we exchanged prednisone to hydrocortisone with a dosage of 10 mg daily after 8 weeks of gestation until delivery.…”

Section: Gestation Managementmentioning

confidence: 99%

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

Zhang

Liu

Zhou

et al. 2022

Preprint

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Background Pituitary stalk interruption syndrome (PSIS) in female patients is mainly characterized by short stature, primary amenorrhea, absent or incomplete sexual maturation, and infertility. Successful pregnancies among these patients are still extremely rare. This study was designed to describe a successful pregnancy and delivery in a Chinese female with PSIS following in vitro fertilization and embryo transfer. Methods Contrast-enhanced magnetic resonance imaging (MRI) scanning of the hypothalamus-pituitary region and genetic analysis of PSIS-associated genes was performed via whole-exome sequencing to identify the potential genetic causes of this disorder. We additionally explored the feasibility to overcome the infertility by controlled ovarian hyperstimulation and frozen-thawed embryo transfer under multiple pituitary hormone supplementation. Results We found that the 28-year-old Chinese woman with PSIS exhibited characteristic symptoms including multiple pituitary hormone deficiency, typical triad signs in MRI scanning, undetectable serum gonadotropins and estradiol levels, and invisible antral follicles in both ovaries. While no pathogenic/possible pathogenic variants that could or partly explain the typical clinical phenotype of PSIS were found following whole-exome sequencing. At the first attempted controlled ovarian hyperstimulation cycle, 14 oocytes were retrieved, and 6 embryos were acquired. Artificial endometrial preparation and frozen-thawed embryo transfer were performed one month after oocyte retrieval, and one day-5 blastocyst was transferred, resulting in a clinical pregnancy. Under close monitoring during pregnancy and multiple hormones dosage modulation, she delivered a healthy boy by elective cesarean section and the newborn developed normally under 1-year follow-up. Conclusions This is the first report of a successful pregnancy achieved in a woman with PSIS following in vitro fertilization and frozen-thawed embryo transfer. Under continuous hormonal supplementation and pregnancy monitoring, in vitro fertilization and embryo transfer might serve as a safe and effective treatment for infertility among PSIS women.

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Successful Pregnancies and Deliveries in a Patient With Evolving Hypopituitarism due to Pituitary Stalk Transection Syndrome: Role of Growth Hormone Replacement

Cited by 8 publications

References 12 publications

Normal-high IGF-1 level improves pregnancy rate after ovarian stimulation in women treated with growth hormone replacement therapy

Normal-high IGF-1 level improves pregnancy rate after ovarian stimulation in women treated with growth hormone replacement therapy

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

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

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