Background: Pregnancy after complete loss of hypophyseal function is rare. Complete lack of ovarian stimulation by FSH and LH results in anovulation and atrophy of the ovaries. We report a patient with panhypopituitirism who achieved pregnancy and delivery through in vitro fertilization (IVF) and embryo transfer (ET).
Case: A 35 year-old lady had undergone four trans-sphenoidal hypophesectomy operations, at 12, 13, 23 and 26 years of age, for recurrent neuroectodermal cyst (embryonic remnant). Her second operation was complicated by panhypopituitirism with severe diabetes insipidus, which was treated with adequate doses of hydrocortisone, L-thyroxine and desmopressin. At the age of 21 years, cyclic Substitution therapy with oestrogen and progesterone was given for primary amenorrhoea; 2 years later, GH therapy was added. At 33 years of age, she requested fertility treatment; GH and cyclic oestrogen and progesterone therapy were stopped, and she underwent an ovulation induction, with goanadotropins, followed by IVF and ET, which resulted in a successful dichorionic twin pregnancy. She was followed up regularly at the combined antenatal clinic; no changes in the steroid, desmopressin, or thyroxine doses were required, and the antenatal period was uneventful. An elective caesarean section was performed at 37 weeks gestation, and healthy twin boys (weighed 3.0 and 3.14 kg) were delivered. Clinical course during puerperium was normal.
Comment: Conception and uncomplicated pregnancy in patients with panhypopituitirism is rare. Well-timed substitution of missing hormones enables normal physical development, and stimulation therapy with gonadotrophins can induce adequate follicular maturation. IVF-ET may be a useful treatment for infertility in patients with panhypopituitirism as it may reduce the incidence of multiple pregnancy, which is associated with higher risk in GH deficient patents.