Postpartum panhypopituitarism with spontaneous pregnancy
- 1 Department of Endocrinology, Lincoln Medical and Mental Health Center, New York, USA
- 2 Department of Endocrinology, Lincoln Medical and Mental Health Center, New York, USA
- 3 Department of Endocrinology, Lincoln Medical and Mental Health Center, New York, USA
- 4 Department of Endocrinology, Lincoln Medical and Mental Health Center, New York, USA
Abstract
We are reporting a case of a patient found to be pregnant in the setting of panhypopituitarism. There are an only few reports of spontaneous pregnancy in patients with panhypopituitarism. This is a 26-year-old female who was admitted due to symptomatic hypoglycemia. Past medical history is significant for uncomplicated pregnancy with C-section delivery 1 year before admission. She was not able to breastfeed the baby in postpartum period. Her menses have been irregular since then. She also noticed increasing fatigue, muscle weakness, episodic diarrhea and 70 pounds weight loss. Physical exam was remarkable for hypotension. Work up showed elevated levels of beta-HCG, hyponatremia, normal anion gap metabolic acidosis, normochromic anemia, and low cortisol levels, appropriate low levels of insulin and C-peptide. Hypoglycemia panel revealed undetectable levels of sulphonylureas. Serum levels for pituitary hor mones showed low levels of ACTH, prolactin and IGF-1, normal levels of FSH, and inappropriate normal levels of TSH in the setting of decreased T4. Stress doses of hydrocortisone were initiated along with thyroid hormone replacement. Brain MRI was found to be unremarkable. Sheehan’s syndrome is a very rare complication of pregnancy when necrosis of the pituitary gland occurs after severe hemorrhage and hypotension upon delivery. Small sella size, disseminated intravascular coagulopathy, stress of the delivery and autoimmunity are also implicated as possible causes of Sheehan’s syndrome. We should be very attentive for symptoms as failure to lactate and failure to resume regular menses after delivery as they can be the first manifestation of the disease. Infertility is common in these patients, but in very few of them gonadotropin response will be present due to residual pituitary function and spontaneous pregnancy can occur. Proper management of these patients during pregnancy will also be very important since a high risk of miscarriages can be expected.
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