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Conception and spontaneous delivery after total hypophysectomy.

Joachim Volz1, Udo Heinrich, Stefanie Volz-Köster

  • 1Department of Gynecology and Obstetrics, University Hospital Mannheim, Mannheim, Germany. joachim.volz@gyn.ma.uni-heidelberg.de

Fertility and Sterility
|March 2, 2002
PubMed
Summary

Pregnancy and spontaneous delivery are possible in women with hypopituitarism. This case report highlights successful fertility treatment and hormone therapy, showing normal labor onset without pituitary oxytocin.

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Area of Science:

  • Reproductive Endocrinology
  • Neuroendocrinology
  • Obstetrics

Background:

  • Total hypophysectomy, the surgical removal of the pituitary gland, results in panhypopituitarism, a condition characterized by deficient hormone production.
  • Panhypopituitarism necessitates lifelong hormone replacement therapy, particularly for reproductive function and pregnancy.
  • Craniopharyngioma is a common cause of pituitary dysfunction requiring hypophysectomy in childhood.

Observation:

  • A 34-year-old woman with a history of childhood hypophysectomy for craniopharyngioma presented with infertility.
  • She underwent successful fertility treatment, followed by comprehensive hormone substitution therapy throughout her pregnancy.
  • The pregnancy progressed without complications, leading to an uncomplicated spontaneous delivery.

Findings:

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  • The patient delivered spontaneously without the need for oxytocin augmentation, either prenatally, intrapartum, or postpartum.
  • This case demonstrates that normal pregnancy and labor are achievable in women with complete absence of pituitary function.
  • Maternal pituitary oxytocin release appears to have a minimal role in initiating and sustaining labor.

Implications:

  • This case suggests that women with hypopituitarism can achieve successful pregnancies and deliveries with appropriate medical management.
  • It challenges the traditional understanding of the essential role of pituitary oxytocin in the labor process.
  • Further research into the neuroendocrine regulation of parturition in the absence of pituitary function is warranted.