Successful twin pregnancy in panhypopituitarism

Abstract

CaseA 35 year old mother of one admitted from our antenatal clinic at 34 weeks of period of gestation for the tertiary care management of a dichorionic diamniotic (DCDA) twin pregnancy.At the age of 20 years, she was diagnosed to have a Rathke's pouch cyst, which was surgically drained and followed by radiotherapy. Post-interventional panhypopituitarism was diagnosed and she was on hormone replacement for hypocortisolism, hypothyroidism and hypopogonadotropic hypogonadism; while growth hormone was not replaced due to lack of funding. She was replaced with oral levo-thyroxine, hydrocortisone (20mg daily in split doses) and the combined oral contraceptive pill (OCP). The patient remained symptomfree and returned to full time work. Upon her request, at the age of 28 years as fertility treatment, induction of ovulation with gonadotrophins was done. During the second cycle of treatment with recombinant FSH for follicular development and maturation with subsequent human chorionic gonadotrophin (hCG) for ovulation following ultrasound ovum tracking coupled, with Intra Uterine Insemination (IUI) resulted in a singleton intrauterine pregnancy. AbstractPanhypopituitarism is characterized by inadequate or absent production of anterior pituitary hormones. This involves hypofunction of most of the major endocrine functions that affect fertility and reproduction. Deficiency of all six anterior pituitary hormones leads to deficiencies of gonadotrophins (FSH, LH), thyroid axis (TSH), adrenocortical hormones (ACTH), Growth Hormone (GH) and Prolactin (PRL). GH and gonadotrophin deficiency are commoner (1) than TSH and ACTH deficiency (2).Although pregnancy after complete loss of pituitary function is uncommon, advances in fertility treatment have led to increased pregnancy rates in these women. 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. Induction of ovulation by means of human or recombinant gonadotrophins is widely used in current practice. Progestrogen support following conception, optimizing other hormonal replacement and careful monitoring throughout pregnancy play a vital role in successful pregnancy outcomes. We report a subject with panhypopituitarism who was managed in our Endocrine Antenatal clinic with successful outcome.