Successful pregnancy following hypophysectomy during the twelfth week of gestation.

Abstract

Panhypopituitarism followed the surgical removal of a chromophobe adenoma from a woman in the twelfth week of pregnancy. The patient received hydrocortisone, desiccated thyroid and vasopressin, and the pregnancy proceeded to term in normal fashion. Minimal lactation occurred post partum. Hormonal excretion was similar to that observed in normal pregnancy. This case illustrates that, provided adequate replacement therapy is given, complete or nearly complete functional ablation of the pituitary during the latter part of the first trimester is compatible with normal human pregnancy. THE origins of many of the hormonal changes observed during pregnancy remain obscure. In particular, evidence in the human concerning the role of the pituitary gland in producing these changes and, even more basic, in maintaining gestation, is understandably meager. Since gonadotropin deficiency accompanies panhypopituitarism and precludes ovulation, such evidence can be obtained only when pituitary deficiency develops after conception. Spontaneous pituitary necrosis is rare during pregnancy; when it occurs, fetal death has been invariable. Little and associates (1) reported that pregnancy was successful in a patient hypophysectomized during the twenty-sixth week. The present report describes endocrine studies, both before and after the delivery of a living child, in a patient whose pituitary was removed during the twelfth week of pregnancy.