Endocrine Abstracts

Introduction: Hundred years ago Harvey Cushing attempt first human pituitary transplantation. This operation, in different modifications, was performed in the next 50 years, but now is used rather only in animal experiment. The problem of effective therapy of hypopituitarism, other that substitution, is however still open. That encouraged us to present a patient 50 years after pituitary xenotransplantation.

Case: A 75-year-old woman was admitted to hospital because of weakness and malaise. The symptoms occurred when her doctor reduced the dose of levothyroxine (because of the low TSH). The result of physical examination was appropriate for age, blood pressure 130/70 mmHg, pulse 75 b/min. Daily rhythm of cortisol was preserved (16.0 μg/dl morning and 8.3 μg/dl afternoon) by normal morning ACTH (31 pg/ml). Serum levels of thyroid hormones were in lower limit of normal range (FT3_3 pg/ml, FT4_0.8 ng/dl), similar as thyroid antibody. TSH, however, was very low (0.04 μIU/ml), correspondingly with low prolactin (0.4 ng/ml), FSH (1.5 mU/ml) and LH (0.75 mU/ml). Other laboratory parameters were normal. MRI showed at the bottom of the Turkish saddle, a small, asymmetrical pituitary, bruised by the arachnoids hernia. According to medical documentation, in 1959 calf pituitary was transplanted into her peritoneal cavity(?), because of Sheehan syndrome. Patient claimed that the graft was ‘not accepted’ contrary to other patients. The menstruation did not return. After that she was treated by different physicians, but complete reconstruction of treatment was impossible.

Conclusion: The postpartum pituitary failure with a preserved adrenal axis function is not so frequent, but not as rare as ectopic xenotransplantation. Was this attempt irrelevant for patient’s health? The answer would be easier if we could observe other patient after successful transplantation. Unfortunately, despite of poor HLA expression in the pituitary, we have never met such person.