High-risk pregnancy management in women with hypopituitarism

Abstract

Pregnancy after complete loss of pituitary function is uncommon. However, advances in fertility treatment have led to increased pregnancy rates in hypopituitary women. We hereby present a literature review of pregnancies affected by hypopituitarism, including a comparison with published controls; further, we add one case report of severe hypopituitarism where third-trimester oxytocin supplementation was performed. As only limited information is available on management and outcome, our purpose was to determine obstetric complications associated with deficiency of pituitary hormones. The analysis of 31 pregnancies in 27 women revealed that hypopituitary women are at increased risk: postpartum hemorrhage occurred in 8.7%, transverse lie in 16%; 42.4% of the newborns were small for gestational age. These findings are supposedly the result of uterine dysfunction caused by hormone deficiency. Oxytocin supplementation was performed with the aim to establish physiologic conditions and to prevent postpartum uterine inertia. In this case substitution may have contributed to correct fetal presentation but did not prevent postpartum hemorrhage. Further investigations into both oxytocin-dependent and -independent mechanisms regulating uterine contractions and contractility are necessary to develop strategies for prevention of uterine inertia in oxytocin-deficient pregnancies.

MANAGEMENT OF ENDOCRINE DISEASE: Fertility, pregnancy and lactation in women with adrenal insufficiency

“…As a potential cause, poor placental function was proposed in these women. In addition to growth retardation, there were more cesarean deliveries (89% vs 11.4%), more transverse lies (15% vs 2.1%) and more postpartum hemorrhages (5.26% vs 1%) (20). High rate of cesarean section was partly due to more malpresentations and partly due to obstetrician's recommendation.…”

“…In contrast, unfavorable outcomes of pregnancies have been described with intrauterine growth retardation (IUGR) being the most common (4.2%; Table 1). In an analysis of 31 pregnancies in 27 women with hypopituitarism of different etiologies, the rate of children who were small for gestational age was found to be higher (38% vs 12.7% in IVF control pregnancies) (20). As a potential cause, poor placental function was proposed in these women.…”

“…For example, patients with complete loss of pituitary function need assistance of artificial reproductive techniques to conceive. These pregnancies are considered as high-risk (19,20).…”

“…To ensure evaluation of cases in the context of modern treatment, only cases dating 1976 onward were considered for inclusion (8,20,26,27,28,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52). This search identified 28 cases of primary AI, a case series with 17 cases of treated adrenocortical carcinoma patients, out of which 7 were included as they were on hydrocortisone treatment following surgical treatment (51) PAI (5) Y (2/5)…”

Successful twin pregnancy in panhypopituitarism

“…Problems related to pregnancy include infertility, lactation failure and increased risk of complications such as miscarriage, anaemia, pregnancy-induced hypertension, placental abruption, premature birth, and postpartum hemorrhage (3,4,5). Conception in this group of patients usually requires the support of assisted reproductive techniques.…”