Spontaneous pregnancy in Sheehan syndrome
Mchirgui Nadia, Hadj Ali Insaf, Khiari Karima, Lakhoua Youssef & Ben Abdallah Nejib
Spontaneous pregnancy in the course of Sheehan syndrome is extremely rare because of gonadotrophic insufficiency, which is almost present.
The aim of our study is to analyse cases of pregnancies occurring spontaneously in patients with Sheehan syndrome.
It is a retrospective study of 46 women who had a Sheehan syndrome diagnosed in the Internal Medicine and endocrinology department of Charles Nicolle Hospital during the period between 1977 and 2008.
Results: The gonadotrophines (FSH, LH) are dosed in 38 patients (87%). Gonadotrophic insufficiency is diagnosed at 86, 8% of cases (33 patients). GnRh test was achieved only in 6 cases (16%). Three patients have a low rate of FSH and LH. Three patients have spontaneous pregnancies. Two of them have a secondary amenorrhea whereas the third has irregular cycles. None patients had a gonadotrophine insufficiency but they had thyrotropin and corticotropin insufficiency. The GnRh stimulation shows a normal response of FSH and LH. None of the three patients has received an ovulation inducing treatment and pregnancy has occurred spontaneously. One patient had three spontaneous abortion and the two others had full term delivery without incident.
Although pregnancy is exceptional in Sheehan Syndrome, the recovery of the hypophyseal function is possible and ovulatory cycles may occur in the evolution of the disease.