Endocrine Abstracts

Introduction: Appropriate replacement therapy of not only gonadotrophins, but other deficient pituitary hormones is important in patients with hypopituitarism for a successful pregnancy. Data regarding GH replacement therapy during pregnancy is limited. We would like to present a case with panhypopituitarism including severe GH deficiency due to Sheehan’s syndrome, who achieved successful pregnancy with GH replacement therapy in the first half of pregnancy.

Case: The patient was a 30-year-old woman with Sheehan’s syndrome diagnosed 3 years after her last delivery. She had panhypopituitarism and was treated with prednisolone, levothyroxine, combined estrogen–progesterone pills and GH. Since the patient wanted to concieve again, ovulation induction was carried out. Conception occurrred after second trial of ovulation induction. Prednisolone and levothyroxine doses were adjusted according to the trimester of her pregnancy and GH replacement therapy was continued until 20 weeks of gestation and the dose was adjusted according to her IGF1 levels. Normal IGF1 levels were maintained without exogenous GH until birth most likely due to placental GH secretion. The pregnancy and delivery were uneventful and the patient gave birth to a term healthy baby.

Conclusion: The dose of deficient hormones should be adjusted according to trimester of pregnancy in patients with hypopituitarism. GH may be used in selected cases with hypopituitarism to increase the success of fertilization and implantation. GH needs to be discontinued in the second half of pregnancy since placental GH is able maintain normal IGF1 levels.