Post‐partum hypoglycemia and hypothermia as first manifestations of lymphocytic adenohypophysitis: A case report

Abstract

Lymphocytic adenohypophysitis is a very rare autoimmune disease characterized by an anterior pituitary infiltration of lymphocytes that cause various symptoms, such as headache, visual disturbance, and hypopituitarism. Lymphocytic adenohypophysitis is more common in women and has a remarkable association with the perinatal period. Recently, we experienced a case of lymphocytic adenohypophysitis shortly after delivery. A 37-year-old primiparous woman delivered her baby at 38 weeks' gestation. The next morning, she presented symptoms of hypoglycemia and hypothermia. Blood testing revealed hypoadrenalism and hypothyroidism. Pituitary magnetic resonance imaging showed characteristic findings consistent with lymphocytic adenohypophysitis. We immediately initiated medication with steroids and levothyroxine. Currently, her pituitary size has normalized and its function has fully recovered. Physical stress resulting from labor and delivery may unmask subclinical lymphocytic adenohypophysitis. Practitioners should keep in mind the possibility of lymphocytic adenohypophysitis in any pregnant women with symptoms of hypoglycemia and hypothermia after delivery.

Revisitation of autoimmune hypophysitis: knowledge and uncertainties on pathophysiological and clinical aspects

“…• The second case described a complex association of post-partum hypothermia, hypoglicemia, hypoadrenalism and hypothyroidism, accompanied by characteristic findings on MRI. Following these results, the authors suggested that practitioners should keep in mind the possibility of LYH in any pregnant women with symptoms of hypoglicemia and hypothermia after delivery [132]. • The rupture of Rathke' cleft cyst may cause lymphocytic-infundibulo-neurohypophysitis.…”

Postpartum Maternal Hypothermia in an Adolescent Patient Following Spontaneous Vaginal Delivery

“…Hypophyseal malfunction may be associated with late pregnancy or the early postpartum period, as the stress of pregnancy and delivery can at times unmask an underlying condition. Lymphocytic adenohypophysitis is one type of hypophyseal disorder that has been uncovered in this fashion and may cause symptoms including hypothermia with presentations similar to sellar compression, diabetes insipidus, hypopituitarism, hypoglycemia, or hyperprolactinemia [13]. Laboratory evaluation and head imaging should be considered to assess for signs of lymphocytic adenohypophysitis.…”