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Postpartum panhypopituitarism with spontaneous pregnancy

DOI: 10.4236/ojim.2013.32008    3,364 Downloads   5,119 Views   Citations

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 hormones 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.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Assumpcao-Morales, M. , Milan, M. , Mohan, V. and Zahra, T. (2013) Postpartum panhypopituitarism with spontaneous pregnancy. Open Journal of Internal Medicine, 3, 34-36. doi: 10.4236/ojim.2013.32008.

References

[1] Kelestimur, F. (2003) Sheehan’s syndrome. Pituitary, 6, 81-88. doi:10.1023/B:PITU.0000023425.20854.8e
[2] Goswami, R., Kochupillai, N., Crock, P.A., Jaleel, A. and Gupta, N. (2002) Pituitary autoimmunity in patients with Sheehan’s syndrome. The Journal of Clinical Endocrinology & Metabolism, 87, 4137-4141. doi:10.1210/jc.2001-020242
[3] Shivaprasad, C. (2011) Sheehan’s syndrome: Newer advances. Indian Journal of Endocrinology and Metabolism, 15, 203-207. doi:10.4103/2230-8210.84869
[4] Sert, M., Tetik, T., Kirim, S. and Kocak, M. (2003) Clinical report of 28 Patients with Sheehan’s syndrome. Endocrine Journal, 50, 297-301. doi:10.1507/endocrj.50.297
[5] Ganie, M.A., Laway, B.A., Qazi, S., Jehangir, M., Butt, T.P. and Koul, S. (2010) Spontaneous successful pregnancy in post-surgical hypopituitarism: A case report. Turkish Journal of Endocrinology & Metabolism, 14, 23
[6] See, T.T., Lee, S.P. and Chen, H.F. (2005) Spontaneous pregnancy and partial recovery of pituitary function in a patient with Sheehan’s syndrome. Journal of the Chinese Medical Association, 68, 187-190. doi:10.1016/S1726-4901(09)70247-3
[7] Zargar, A.H., Masoodi, S.R., Laway, B.A., Sofi, F.A. and Wani, A.I. (1998) Pregnancy in Sheehan’s syndrome: A report of three cases. Journal of the Association of Physicians of India, 46, 476-478.
[8] Bhagat, M., Salhan, S., Sarda, N. and Bajaj, B. (2011) Spontaneous pregnancy in a patient with Sheehan’s syndrome. JK Science, 13.
[9] Vieira, H.B., Knoepfelmacher, M., Salgado, L.R., Wajchenberg, B.L. and Liberman, B. (1995) Preservation of gonadotrophic function and pregnancy in Sheehan’s syndrome: A case report and review of the literature. Revista da Associa??o Médica Brasileira, 41, 135-138.
[10] Nadia, M., AliInsaf, H., Karima, K., Youssef, L. and AbdallahNeji, B. (2010) Spontaneous pregnancy in Sheehan syndrome. Endocrine Abstract, 22, 490.
[11] Daniel, A., Ezzat, S. and Greenblatt, E. (2012) Adjuvant growth hormone for ovulation induction with gonadotropins in the treatment of a woman with hypopituitarism. Case Reports in Endocrinology, 2012. doi:10.1155/2012/356429

  
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