Endocrine Abstracts

Introduction: Lymphocytic hypophysitis is a rare inflammatory disease of the pituitary gland. The aetiology is unknown though probably of autoimmune origin. This condition usually occurs in women during pregnancy or in the post partum period. Recurrent disease in pregnancy is rare.

Case report: We present a 35-year-old patient of African origin who initially presented in 2004 at 12 weeks gestation with headaches, a third nerve palsy but no visual field defects. She responded to high dose steroids. A healthy baby was delivered. Post partum she developed galactorrhoea responsive to cabergoline 500 micrograms twice a week. She also developed secondary hypothyroidism treated with thyroxine 50 μg daily. Treatment with low dose steroids (prednisolone 5 mg) was continued. Steroid withdrawal was hampered by severe headaches. Before receiving family planning advice she had an unplanned conception in 2006 with a spontaneous abortion. Repeat pituitary MRI showed resolving hypophysitis.

She discontinued all medication and again become pregnant in 2007. Visual fields and cranial nerves were normal at 16 weeks gestation. She was again commenced on prednisolone 5 mg and thyroxine 50 μg daily. At 24 weeks gestation MRI showed a dramatic increase in pituitary size with supra sellar extension. Visual field plotting showed right homonymous hemianopia.

Prednisolone dose was increased to 40 mg once daily. At 33 weeks her symptoms improved with complete normalization of her visual fields.

Discussion: Recurrent Lymphocytic Hypophysitis in pregnancy is rare. The clinical course may be complicated, emphasizing the need for rigorous long-term observation in the preconception stage and during pregnancy. Corticosteroids are the therapy of choice in the inflammatory stage and should be undertaken as soon as the diagnosis has been established. Regular multi-disciplinary surveillance is required.