title: Post-partum hypoglycemia and hypothermia as first manifestations of lymphocytic adenohypophysitis: A case report.
abstract: Lymphocytic adenohypophysitis is a very rare autoimmune disease characterized by an anterior pituitary infiltration of lymphocytes that cause various symptoms, such as headache, visual disturbance, and hypopituitarism. Lymphocytic adenohypophysitis is more common in women and has a remarkable association with the perinatal period. Recently, we experienced a case of lymphocytic adenohypophysitis shortly after delivery. A 37-year-old primiparous woman delivered her baby at 38 weeks' gestation. The next morning, she presented symptoms of hypoglycemia and hypothermia. Blood testing revealed hypoadrenalism and hypothyroidism. Pituitary magnetic resonance imaging showed characteristic findings consistent with lymphocytic adenohypophysitis. We immediately initiated medication with steroids and levothyroxine. Currently, her pituitary size has normalized and its function has fully recovered. Physical stress resulting from labor and delivery may unmask subclinical lymphocytic adenohypophysitis. Practitioners should keep in mind the possibility of lymphocytic adenohypophysitis in any pregnant women with symptoms of hypoglycemia and hypothermia after delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Sakai, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Koyama
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Sakai, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Okuno
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Sakai, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Naoi
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Sakai, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Sakai, Japan.
authors.forename: Kimiaki
authors.initials: K
authors.lastname: Ozaki
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Sakai, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Shiki
mesh_terms: D000309:Adrenal Insufficiency / Q000097:blood; D000328:Adult; D000069281:Autoimmune Hypophysitis / Q000175:diagnosis*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007003:Hypoglycemia; D007035:Hypothermia; D007037:Hypothyroidism / Q000097:blood; D008279:Magnetic Resonance Imaging; D010298:Parity; D011247:Pregnancy; D011644:Puerperal Disorders / Q000175:diagnosis*
keywords: hypoglycemia; hypopituitarism; hypothermia; lymphocytic adenohypophysitis; lymphocytic hypophysitis