title: Recovery of HPA Axis Function After Successful Gonadotropin-Induced Pregnancy and Delivery in a Woman With Panhypopituitarism: Case Report and Review.
abstract: Hypopituitarism is defined as the partial or complete defect of anterior pituitary hormone secretion. Patients with hypopituitarism usually need life-long hormone replacement therapy. However, in this case, we report a patient with panhypopituitarism whose hypothalamus-pituitary-adrenal (HPA) axis function was completely recovered after pregnancy and delivery. In this case study, we reported the case management and conducted a review of literature to identify the possible mechanism of pituitary function recovery. The patient who suffered from secondary amenorrhea was found a nonfunctioning pituitary macroadenoma, and the hormone test showed serum cortisol, FT3, FT4, thyrotropic hormone, and prolactin were at normal range. After surgical removal of the tumor which invasion in the sellar region, the patient had panhypopituitarism confirmed by the routine hormone test. Though spontaneous pregnancy is impossible in female patients with panhypopituitarism, the patient was restored fertility by the help of artificial reproductive techniques. After the confirmation of the pregnancy, levothyroixine was increased to 75 μg daily and readjusted to 150 μg daily before delivery according to the monthly measurement thyroid function. Hydrocortisone 10 mg daily replaced cortisone acetate; the dose was increased according to the symptoms of morning sickness. A single stress dose of hydrocortisone (200 mg) was used before elective cesarean delivery and was tapered to the dose of 10 mg per day in 1 week. Levothyroixine was reduced to 75 μg daily after delivery. During follow-up, her hypothalamus-pituitary-adrenal (HPA) axis function was completely recovered. The peak serum cortisol level could increase to 19.08 μg/dL by insulin-induced hypoglycemia. However, growth hormone remained unresponsive to the insulin-tolerance test, and thyroid hormone still needed exogenous supplementation. Hormone replacement therapy needed closely followed by endocrinologist and multidisciplinary cooperation during the pregnancy of patients with hypopituitarism. This case indicates that the pituitary function may partially recover after pregnancy in panhypopituitarism patients.
authors.affiliation: From the Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai (YW, QZ, XZ, MH, YL, HY); Assistant Reproductive Technology Center, First Maternity and Infant Health Hospital, Tongji University, Shanghai (JY); and Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai (XS, SL, YW).
authors.forename: Yi
authors.initials: Y
authors.lastname: Wang
authors.forename: Qiongyue
authors.initials: Q
authors.lastname: Zhang
authors.forename: Jianzhi
authors.initials: J
authors.lastname: Yang
authors.forename: Xiaolong
authors.initials: X
authors.lastname: Zhao
authors.forename: Min
authors.initials: M
authors.lastname: He
authors.forename: Xuefei
authors.initials: X
authors.lastname: Shou
authors.forename: Shiqi
authors.initials: S
authors.lastname: Li
authors.forename: Yiming
authors.initials: Y
authors.lastname: Li
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Hongying
authors.initials: H
authors.lastname: Ye
mesh_terms: D000236:Adenoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D006062:Gonadotropins / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007018:Hypopituitarism / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology*; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D010913:Pituitary-Adrenal System / Q000502:physiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D020127:Recovery of Function; D027724:Reproductive Techniques, Assisted; D013974:Thyroxine / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D005300:Fertility Agents, Female; D006062:Gonadotropins; D013974:Thyroxine; D006854:Hydrocortisone