Endocrine Abstracts

A 34-year-old lady attended clinic-requesting information on recombinant prolactin to assist with breast feeding as she was 32 weeks gestation with her third pregnancy having failed to lactate after her first two pregnancies.

In 2003 she developed pre-eclampsia during her first pregnancy and required delivery by Ventouse extraction. She had a significant post-partum haemorrhage of 1200 mls with haemoglobin 7g/dl but no evidence of cardiovascular compromise. Despite early colostrum she was unable to breastfeed. She had 1 reported normal period after the birth but then restarted the OCP.

She was later referred to the rheumatologists with arthralgia, which was investigated with routine bloods, auto immune profile and thyroid function. On the grounds of her TFT’s she had a pituitary profile performed.

A likely diagnosis of possible Sheehan’s syndrome was made and the patient was started on hydrocortisone replacement. There had been no headaches or visual field abnormalities. Her combined TRH/ GnRH test showed an adequate response of thyroid and gonadotrophin axis but her prolactin remained unrecordable as did her adrenocortical response. MRI at the time and on repeat was normal.

She went on to have two further uncomplicated pregnancies but was unable to breastfeed.

In this lady MRI was normal acutely and at follow up and we found a combined persistent ACTH and prolactin deficiency but our patient has gone on to have two successful pregnancies. This is an unusual constellation of findings which probably represents lymphocytic hypophysitis rather than Sheehan’s Syndrome.

Lymphocytic hypophysitis and Sheehan’s diagnosis can be difficult to distinguish but there may be clinical reason to do so as spontaneous resolution of lymphocytic hypophysitis has been documented as has progressive pituitary failure.