Growth hormone replacement has not been recommended for use during pregnancy, due to lack of controlled trials to study its effects on the mother and the baby. We present a patient with hypopitiutarism on rhGH replacement which was continued during pregnancy with no adverse effects.
A 35 years old lady, diagnosed ages 30 with pan-hypopituitarism secondary to non-functioning pituitary adenoma, she underwent trans-sphenoidal resection of the adenoma in 2002 and 2005. Post surgery radiotherapy was deferred because of the patients concern about fertility. Her blood results following surgery were as follow; IGF1 23.3 nmol/l, (4064.5), FT4 19.7 pmol/l, TSH 0.07 min/l, TT3 2.4 nmol/l (on 125 Mcg thyroxine), FSH 6.6 IU/l, LH 9.8 IU/l, oestradiol 288 pmol/l, prolactin 478 mu/l. GST post operatively confirmed normal cortisol reserve (peak cortisol of 591 nmol/l) and GHD (peak GH 1.1 ug/l). She was started on GH replacement (0.5 mg SC daily) and continued on thyroxine replacement therapy.
Fertility remained her main concern and she underwent IVF, resulting in pregnancy, unfortunately on discontinuation of her rhGH she miscarried at 5 weeks gestation. Recombinant (rh) GH was recommenced, at the patients request, with the intention to continue throughout pregnancy. A further IVF treatment resulted in pregnancy and rhGH continued throughout pregnancy. Growth hormone dosage remained unchanged up to 36 weeks of gestation, when rhGH stopped as her IGF-1 levels rose above the normal limits. Our patient had uneventful delivery at full term and currently breast feeding.
We have demonstrated that GH replacement in this patients pregnancy was associated with a successful outcome.