Endocrine Abstracts

Introduction: Pregnancy in hypopituitary women is a rare and poorly studied clinical condition. Management difficulties and obstetrical complications have been associated with this condition.

Objectives: To define the characteristics, follow-up and perinatal outcomes in hypopituitary pregnant women attended at our centre.

Methods: The clinical data of the hypopituitary pregnant women (deficiency of two or more pituitary hormones), and details on delivery and the newborn are collected prospectively. Here we present eight pregnancies in seven women who had been diagnosed with hypopituitarism before pregnancy.

Results: The median age of the patients was 35 years; hypopituitarism had been diagnosed a mean of 19.5 years prior to pregnancy. The cause of hypopituitarism was pituitary agenesis in two patients, macroprolactinoma in another 2, 1 corticotroph adenoma, 1 hypophysitis, 1 empty sella and 1 granular cell tumour. All pituitary tumours had undergone surgery, but none had received radiotherapy. At the beginning of pregnancy, no patient presented hormonal hypersecretion. There were 7 GH and GnRH deficits, 6 of TSH, 3 of ACTH and 2 of ADH. Five women with GH deficiency had received GH substitution therapy. Six women required assisted reproduction techniques (4 controlled ovarian stimulation, 1 intrauterine insemination, 1 in vitro fertilization). During pregnancy, GH replacement was stopped, hydrocortisone dose was maintained, whereas levothyroxine and desmopressin doses were increased. One patient developed de novo diabetes insipidus. No acute complications were identified. Gestational age at birth ranged from 36⁺ to 42⁺ weeks; five patients required labour induction. Delivery was by caesarean section in five cases and vaginal in 3. No foetal distress occurred. Average weight of the newborns (five girls, three boys) was 3200 g and the 5 min Apgar score was 9. No relevant perinatal complications were observed. Four patients experienced a milk surge.

Conclusion: The perinatal outcome of this group of patients with hypopituitarism was satisfactory. It is important to keep in mind the possibility of de novo hormonal deficiencies during pregnancy.