ECE2018 Guided Posters Female Reproduction (11 abstracts)
Favorable prognosis of pregnancies in 28 hypopituitary women: Retrospective multicentric study on 39 pregnancies
Eve Melloul 1 , Olivier Chabre 1 , Philippe Caron 2 , Jacques Young 3 , Helène Bry 3 , Gerald Raverot 4 , Francoise Borson Chazot 4 , Aurélie Brosse 5 , Thierry Brue 6 , Frederic Castinetti 6 , Pascale Hoffmann 7 & Laure Villaret 7
1Endocrinologie, Centre Hospitalier Universitaire Albert Michallon, Grenoble, France; 2Endocrinologie, Centre Hospitalier Universitaire Larrey, Toulouse, France; 3Endocrinologie, Centre Hospitalier Universitaire Kremlin-Bicêtre, Paris, France; 4Endocrinologie, Groupement Hospitalier Est, Bron, France; 5Médecine de la Reproduction Gynécologie Obstétrique, Groupement Hospitalier Est, Bron, France; 6Endocrinologie, Assistance publique hôpitaux de Marseille, Marseille, France; 7Médecine de la Reproduction Gynécologie Obstétrique, Centre Hospitalier Universitaire Albert Michallon, GRENOBLE, France.
Background: Pregnancy in women with hypopituitarism has been described as presenting high risks of maternal and fetal complications but this is only based on 2 small size series.
Objective: To reassess the prognosis of pregnancy in women with hypopituitarism.
Methods: Multicentric, observational, retrospective study including 39 pregnancies in 28 women with gonadotropic insufficiency and at least one other pituitary hormone deficiency followed in the last 22 years in five French tertiary centers. Due to the a multi-disciplinary approach, the substitutive treatment of corticotroph and thyrotropin insufficiencies were followed by endocrinologists. We collected the data regarding infertility management, pregnancy outcome, obstetrical or endocrine complications and new born children characteristics.
Results: 28 women with a median age of 30 years (25–41) were included. Pituitary insufficiency was linked to the following lesions and their medical, surgical or radiotherapic treatments: Craniopharyngioma (n=8); different adenomas (n=8); Sheehan Syndrome (n=4); Hypophysitis (n=3); Congenital (n=3); Rathke cyst (1); Pinealoma (1). Pituitary deficiences were gonadotropic (100%) Thyrotropic (92%) Somatotropic (81%) Corticotropic (64%) Diabetes inspidus (39%). 26 patients with thyrotropin insufficiency were treated by L-thyroxine adjusted during all the pregnancy. 18 were treated by hydrocortisone for corticotroph insufficiency. Pregnancy was obtained by ovarian stimulation by FSH and ovulation stimulation by hCG in all but 4 cases but in vitro fertilization was required in only 6 cases (19%). Among 39 pregnancies, 36 live births (92%) (25 singletons and 11 twins) occured, and 3 ectopic pregnancies, 5 miscarriages and 1 intra uterine fetal death were observed. For all births, the rate of caesarean section was 42%: 36% for singletons and 66% for twins. The new-borns were healthy with a median weight of 3120 g (570–4250) and a median length of 50 cm (31–53), 22% were preterm babies (4% for singletons and 58% for twins) and 27% had a low birth weight (12% for singletons and 58% for twins). No maternal complications related to pituitary insufficiency occurred. The pregnancies outcomes were comparable to those in the French population for singleton pregnancies but there were less favorable for twin pregnancies. Five out of six twin pregnancies had at least one perinatal complication with one intrauterine fetal death.
Conclusion: In this study we found a good prognosis of pregnancies in women with hypopituitarism followed in tertiary centers by a multi-disciplinary team. However because twin pregnancies showed more perinatal complications than in the general population ovarian stimulation should be carefully monitored to favor singleton pregnancies.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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