Primary hypothyroidism, pituitary insufficiency and pregnancy. A case report

A 23-year-old woman presented with primary hypothyroidism and inability to lactate following uneventful childbirth. Endocrine evaluation revealed that she had autoimmune hypothyroidism and deficiencies of ACTH and prolactin. Despite partial hypopituitarism, she again conceived spontaneously, had an uneventful pregnancy and delivery but failed to lactate. Radiologic evaluation of the hypophysis, including CAT scan, was normal, and antibodies to anterior pituitary cells were not detected. The etiology of the pituitary insufficiency might have been autoimmune hypophysitis , a recently described entity in which anterior pituitary, along with the other endocrine glands, is destroyed by an autoimmune process. The clinical course suggested that women with pituitary insufficiency, although rare, are able to conceive and carry the pregnancy to term. Our patient illustrates that prolactin insufficiency does not preclude a successful outcome of pregnancy but can result in no lactation.