Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2015) 37 GP20.03 | DOI: 10.1530/endoabs.37.GP.20.03

ECE2015 Guided Posters Pituitary – Hypopituitarism (9 abstracts)

Timing is everything? Postpartum pituitary dysfunction – variability of clinical and radiological presentation

Amit Tirosh 1, , Hiba Masri Iraqi 1, , Dania Hirsch 1, , Eyal Robenshtok 1, , Uri Yoel 3 , Yoel Toledano 2, , Orit Twito 2, , Gloria Tsvetov 1, & Ilan Shimon 1,

1Endocrine Institute, Rabin Medical Center, Petah Tiqva, Israel; 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 3Endocrine Institute, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel; 4Endocrinology clinic, Division of maternal Fetal Medicine, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tiqva, Israel; 5Endocrine Institute, Meir Medical Center, Kfar Saba, Israel.

Introduction: Two aetiologies are responsible for postpartum hypopituitarism; Sheehan’s syndrome which develops following traumatic labour, and lymphocytic hypophysitis. Since management of lymphocytic hypophysitis does not require surgery in most cases, pathology is usually absent, and the clinical presentation, in combination with laboratory and imaging characteristics establish the diagnosis. We aimed to describe the various patterns of presentation, including assisting analyses, among women with probable lymphocytic hypophysitis.

Methods: A retrospective study of women with pituitary dysfunction presented immediately or several months following delivery. Clinical characteristics data, pituitary hormone levels, and imaging findings were collected.

Results: Eight women were included; mean age at delivery was 34.8±7.4 years.

Most patients (6/8) presented with breastfeeding difficulty, and 5/8 reported headache. Among the patients with headache, 2/5 presented during pregnancy, and the others – 2, 4 and 9 months following delivery. Hypopituitarism symptoms appeared immediately after delivery in half of the patients, between 7–12 months in 3/8; in one patient severe headache was the sole complaint. All patients had central hypocortisolism, hypogonadotrophic hypogonadism, and growth hormone deficiency, and 7/8 had central hypothyroidism. Prolactin levels were low in 2/8. None of the patients had diabetes insipidus. Five patients passed MRI within 3 months of symptom onset, four of them (80%) complained about headaches. These patients had either normal pituitary structure (2/5), pseudo-adenoma (1/5) or diffusely enlarged and hyperintense gland, suggestive for hypophysitis (2/5). Three patients have been diagnosed more than a year following presentation, all had reduced pituitary volume on MRI, and two of them had panhypopituitarism.

Conclusion: Over 300 cases of autoimmune hypophysitis were reported in the literature. Thus, a high index of suspicion is required to identify women in the postpartum period with breastfeeding difficulty, with or without headaches, and to study their pituitary function.

Article tools

My recent searches

No recent searches.