Endocrine Abstracts

JOINT1480

Introduction: Recurrent pregnancy loss (RPL) is a polyetiological complication of pregnancy, primarily caused by dysfunction of the reproductive system. Endocrine factors play a significant role in the etiology of spontaneous miscarriages. The prevalence of endocrine factors in recurrent pregnancy loss is approximately 17%. The most common hormonal disorders contributing to RPL include ovarian hypofunction, hyperandrogenism of various origins, thyroid hypofunction, hyperprolactinemia, and thyroid pathology.

Objective: Present a clinical case with RPL.

Materials and methods: The primary documentation has been reviewed: medical history, results of clinical, laboratory, and ultrasound examinations.

Results: In January 2023, a 28-year-old woman consulted an endocrinologist to identify possible endocrine causes of RPL. Medical history revealed an irregular menstrual cycle (2537 days). She had experienced four pregnancies: the first ended in preterm delivery at 30 weeks due to placental insufficiency, while the others resulted in spontaneous miscarriages at 9, 10, and 8 weeks. Complaints included fatigue, irritability, emotional instability, headaches, and menstrual irregularities. Hormonal studies were recommended. Test results obtained the following day revealed elevated prolactin levels (63.5 ng/ml) and TSH (8 mU/L), with T4 and T3 levels within the normal range. An MRI of the brain was subsequently recommended to rule out a prolactinoma. After thorough examinations, the patient was diagnosed with idiopathic hyperprolactinemia and subclinical hypothyroidism. Dopamine agonists and hormone replacement therapy were prescribed. Four months later, the patient became pregnant, and all medications were discontinued. However, signs of a threatened miscarriage appeared at 8 weeks. Hormonal analysis revealed elevated prolactin (200 ng/ml) and TSH (6 mU/l)levels, with a decrease in inhibin A (420 pg/ml). Treatment was resumed based on these findings. The patient was closely monitored throughout the pregnancy, with periodic assessments of prolactin, TSH, and inhibin A levels. Treatment was adjusted according to hormone levels. In 2024, the pregnancy concluded with a full-term delivery at 39 weeks without complications.

Conclusion: Elevated prolactin and TSH levels are associated with decreased inhibin A, indicating an increased risk of pregnancy loss. Inhibin A may be used as a predictor of RPL development linked to endocrine factors (e.g., hyperprolactinemia and hypothyroidism).