Endocrine Abstracts

Panhypopituitarism is a complex endocrine condition often thought to preclude breastfeeding due to its inherent hormonal deficiencies. Breastfeeding, however, is an important health behavior that reduces maternal morbidity and mortality. Breastfeeding reverses cardiometabolic risk factors acquired during pregnancy by reducing visceral fat and cholesterol, lowering risks of type 2 diabetes, cardiovascular and neurovascular comorbidity, and breast and ovarian cancer. We report on the management and outcome of a 34-year-old parturient with panhypopituitarism secondary to craniopharyngioma treatment who desired to breastfeed. The patient, with endocrine and lactation specialist support, prepared prenatally for lactation. Post-delivery, she used intranasal oxytocin to stimulate milk ejection and was treated with galactagogues. Despite her prolactin levels remaining below typical lactogenic ranges and the need for formula supplementation, she established a partial breastfeeding routine. Key to this success was the use of a supplemental nursing system, combined with regular milk expression and multidisciplinary support. We also reviewed published cases of women with hypopituitarism or panhypopituitarism who gave birth, where there was mention of attempted breastfeeding with successful or unsuccessful results. Our literature review, encompassing 33 articles and detailing 85 live births, found that a minority of these women succeeded in breastfeeding, with 96% of unsuccessful cases lacking documentation of lactation support. Our analysis also suggests a correlation between low prolactin levels or inadequate prolactin response to TRH-stimulation testing with the absence of spontaneous lactation post-delivery. These findings suggest that recombinant prolactin may be of benefit in the management of lactation in women with panhypopituitarism. Following these results, our case challenges the assumption that achieving successful breastfeeding is unfeasible in women with panhypopituitarism. The innovative application of intranasal oxytocin with a lactation plan of care that involves multispecialty involvement demonstrates a novel approach to managing such cases. This report emphasizes the importance of reassessing the lactation potential in women with endocrine disorders and encourages proactive, multidisciplinary support in their care.