Harinarayan CV1*, Anisha Tandon2 and Khalida Parveen Andan3
1Department of Medicine & Endocrinology, Institute of Endocrinology, Diabetes, Thyroid and Osteoporosis Disorders, Sakra World Hospitals, Bangalore, Karnataka, India Department of Medicine & Endocrinology, Saveetha Institute of Medical and Technical Sciences University, Saveetha Medical College, Chennai, India 2Department of Radiology, Sarka World Hospitals, Bangalore, Karnataka, India 3Department of Laboratory Medicine, Sarka World Hospitals, Bangalore, Karnataka, IndiaFulltext PDF
Auto Immune Hypophysitis (AIH) affects women of reproductive age group presenting in early or late pregnancy. ACTH followed by TSH and gonadotropin is the sequence of hormone deficiencies. Steroids form the main stay of the treatment. They recover in 6-9 months. Surgery is rarely required. This report discusses conception in a patient with missed diagnosis of AIH. 29-year women with 8 weeks amenorrhea (G2P1L1A0) presented with unconscious state in the emergency room. Four years back, in 8th month of first pregnancy she had headache and weight loss which continued one year postpartum. Her cycles resumed 3rd month postpartum and was regular till present conception. She breastfed for 18 months. Random blood sugar was 22 mg/dl with normal electrolytes, liver and thyroid functions. Paired 8 am cortisol-ACTH was 0.13 ug/ml - 4.87 pg/ml. Incremental response of plasma cortisol after ACTH stimulation was absent. Adrenal and thyroid autoantibodies were negative. MRI of sella revealed a small pituitary gland with signal changes in pars intermedia and infundibulum, interpreted as sequel of prior apoplexy or AIH. Other anterior pituitary functions were normal. She was supplemented with high dose steroids and carried the pregnancy to 33.4 weeks and delivered a healthy male child. Repeat MRI 6 weeks postpartum revealed an increase in size of pituitary gland with normal posterior pituitary signal and stalk enhancement. CT adrenal-small size gland measuring 1 mm × 1.5 mm. To the best of our knowledge this is the first reported case of untreated AIH resulting in successful spontaneous conception, diagnosed and treated leading to normal delivery with resumption of cycles postpartum.
Harinarayan CV, Tandon A, Parveen Andan K. Unconsciousness in a 29-Year-Old Woman with 8 Weeks Amenorrhea. Ann Clin Case Rep. 2020; 5: 1836. ISSN: 2474-1655.