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Hormones

, Volume 14, Issue 1, pp 70–80 | Cite as

Pituitary disorders in pregnancy

  • Alexandra Chrisoulidou
  • Maria Boudina
  • Niki Karavitaki
  • Eleni Bill
  • John Wass
Review

Abstract

The pituitary gland is significantly affected during gestation in terms of both size and function. Due to this physiologic adaptation, endocrine evaluation and interpretation of imaging is far more complex than in the non-pregnant state. Pituitary disorders are rare in pregnancy, as they are usually associated with gonadal dysfunction, thereby posing difficulties with fertility. This review will focus on pituitary adenomas (prolactinomas, GH-secreting and ACTH-secreting), their diagnostic handicaps and the recommendations for treatment. We will also discuss the two pituitary disorders encountered in pregnancy, Sheehan’s syndrome and lymphocytic hypophysitis.

Key words

Pituitary gland Pregnancy 

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References

  1. 1.
    Feldt-Rasmussen U, Mathiesen ER, 2011 Endocrine disorders in pregnancy: physiological and hormonal aspects of pregnancy. Best Pract Res Clin Endocrinol Metab 25: 875–884.PubMedGoogle Scholar
  2. 2.
    Karaca Z, Kelestimur F, 2010 Pregnancy and other pituitary disorders (including GH deficiency). Best Pract Res Clin Endocrinol Metab 25: 897–910.Google Scholar
  3. 3.
    Fernadez A, Karavitaki N, Wass JA, 2010 Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf) 72: 377–382.Google Scholar
  4. 4.
    Kaiser UB, 2012 Hyperprolactinemia and infertility: new insights. J Clin Invest 122: 3467–3468.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Molitch M, 2002 Medical management of prolctin-secreting pituitary adenomas. Pituitary 5: 55–65.PubMedGoogle Scholar
  6. 6.
    De Bernai M, de Villamizar M, 1982 Restoration of ovarian function by low nocturnal single daily doses of bromocryptine in patients with the galactorrheaamenorrhea syndrome. Fertil Steril 37: 392–396.Google Scholar
  7. 7.
    Holmgren U, Bergstrand G, Hagenfeldt K, Werner S, 1986 Women with prolactinomas-effect of pregnancy and lactation on serum prolactin and on tumour growth. Acta Endocrinol 111: 452–459.PubMedGoogle Scholar
  8. 8.
    Ono M, Miki N, Amano K, et al, 2010 Individualised high dose cabergoline therapy for hyperprolactinemic infertility in women with micro- and macroprolactinomas. J Clin Endocrinol Metab 95: 2672–2679.PubMedGoogle Scholar
  9. 9.
    Molitch ME, 2006 Pituitary disorders during pregnancy. Endocrinol Metab Clin North Am 35: 99–116.PubMedGoogle Scholar
  10. 10.
    Colao AM, Abs R, Barcena DG, Chanson P, Paulus W, Kleinberg DL, 2008 Pregnancy outcomes following cabergoline treatment: extended results from a 12-year observational study. Clin Endocrinol (Oxf) 68: 66–71.Google Scholar
  11. 11.
    Ciccareli E, Camanni E, 1996 Diagnosis and drug therapy of prolactinoma. Drugs 51: 954–965.Google Scholar
  12. 12.
    Stalldecker G, Mallea-Gil MS, Guitelman M, et al, 2010 Effects of cabergoline on pregnancy and embryo-fetal development: retrospective study on 103 pregnancies and a review of the literature. Pituitary 13: 345–350.PubMedGoogle Scholar
  13. 13.
    Webster J, 1996 A comparative review of the tolerability profile of dopamine agonists in the treatment of hyperprolactinemia and inhibition of lactation. Drug Saf 14: 228–238.PubMedGoogle Scholar
  14. 14.
    Crosignani PG, 2006 Current treatment issues in female hyperprolactinemia. Eur J Obstet Gynecol Reprod Biol 125: 152–164.PubMedGoogle Scholar
  15. 15.
    Barlier A, Jaquet P, 2006 Quinagolide-a valuable treatment option for hyperprolactinemia. Eur J Endocrinol 154: 187–195.PubMedGoogle Scholar
  16. 16.
    Molitch ME, 1985 Pregnancy and the hyperprolactinemic woman, N Engl J Med 312: 1364–1370.PubMedGoogle Scholar
  17. 17.
    Karaca Z, Tanriverdi F, Unluhizarci K, Kelestimur F, 2010 Pregnancy and pituitary disorders. Eur J Endocrinol 162: 453–475.PubMedGoogle Scholar
  18. 18.
    Gillam MP, Molitch ME, Lombardi G, Colao A, 2006 Advances in the treatment of prolactinomas. Endocr Rev 27: 485–534.Google Scholar
  19. 19.
    Kupersmith MJ, Rosenberg C, Kleinberg D, 1994 Visual loss in pregnant women with pituitary adenomas. Ann Intern Med 121: 473–477.PubMedGoogle Scholar
  20. 20.
    Wang AT, Mullan RJ, Lane MA, et al, 2012 Treatment of hyperprolactinemia: a systematic review and meta-analysis. Syst Rev 1: 33.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Melmed S, Casanueva FF, Hoffman AR, et al, 2011 Diagnosis and treatment of hyperprolactinemia: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 96: 273–288.Google Scholar
  22. 22.
    Melmed S, Casanueva FF, Klibanski A, et al, 2013 A consensus on the diagnosis and treatment of acromegalic complications. Pituitary 16: 294–302.PubMedGoogle Scholar
  23. 23.
    Urdl W, 1988 Polycystic ovarian disease: endocrinological parameters with spccific reference to growth hormone and somatomedin C. Arch Gynecol Obstet 243: 13–36.PubMedGoogle Scholar
  24. 24.
    Molitch ME, 2003 Pituitary tumors and pregnancy. Growth Hormone & IGF Research 13: suppl A: 38–44.Google Scholar
  25. 25.
    Grynberg M, Salenave S, Young J, Chanson P, 2010 Female gonadal function before and after treatment of acromegaly. J Clin Endocrinol Metab 95: 4518–4525.PubMedGoogle Scholar
  26. 26.
    Isoton AC, Wender MC, Czepielewski MA, 2008 The influence of estrogen and progesterone replacement on growth hormone activity in women with hypopituitarism. Arq Bras Endocrinol Metab 52: 901–916.Google Scholar
  27. 27.
    Cheng S, Grasso L, Martinez-Orozco JA, et al, 2012 Pregnancy in acromegaly: experience from two referral centers and systematic review of the literature. Clin Endocrinol (Oxf) 76: 264–271.Google Scholar
  28. 28.
    Caron P, Broussaud S, Bertherat J, et al, 2010 Acromegaly and pregnancy: a retpospective multicenter study of 59 pregnancies in 46 women. J Clin Endocrinol Metab 95: 4680–4687.PubMedGoogle Scholar
  29. 29.
    Maffei P, Tamagno G, Nardelli GB, et al, 2010 Effects of octreotide exposure during pregnancy in acromegaly. Clin Endocrinol (Oxf) 72: 668–677.Google Scholar
  30. 30.
    Koshy TG, Rajaratnam S, Mathews JE, Rajshekhar V, 2012 Acromegaly in pregnancy. Indian J Endocrinol Metab 16: 1029–1031.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Atmaca A, Dagdelen S, Erbas T, 2006 Follow-up of pregnancy in acromegalic women: different presentations and outcomes. Exp Clin Endocrinol Diabetes 114: 135–139.PubMedGoogle Scholar
  32. 32.
    Cozzi R, Attanasio R, Barausse M, 2006 Pregnancy in acromegaly: a one-center experience. Eur J Endocrinol 155: 279–284.PubMedGoogle Scholar
  33. 33.
    De Menis E, Billeci D, Marton E, Gussoni G, 1999 Uneventful pregnancy in an acromegalic patient treated with slow-release lanreotide: a case report. J Clin Endocrinol Metab 84: 1489.PubMedGoogle Scholar
  34. 34.
    Fassnacht M, Capeller B, Arlt W, Steck T, Allolio B, 2001 Octreotide LAR treatment throughout pregnancy in an acromegalic woman. Clin Endocrinol (Oxf) 55: 411–415.Google Scholar
  35. 35.
    Brian SR, Bidlingmaier M, Wajnrajch MP, Weinzimer SA, Inzucchi SE, 2007 Treatment of acromegaly with pegvisomant during pregnancy: maternal and fetal effects. J Clin Endocrinol Metab 92: 3374–3377.PubMedGoogle Scholar
  36. 36.
    Hierl T, Ziegler R, Kasperk C, 2000 Pregnancy in persistent acromegaly. Clin Endocrinol (Oxf) 53: 262–263.Google Scholar
  37. 37.
    Kaltsas GA, Korbonits M, Isidori AM, et al, 2000 How common are polycystic ovaries and the polycystic ovarian syndrome in women with Cushing’s syndrome? Clin Endocrinol (Oxf) 53: 493–500.Google Scholar
  38. 38.
    Hunt AB, McConahey CW, 1953 Pregnancy associated with diseases of the adrenal glands. Am J Obstet Gynecol 66: 970–987.PubMedGoogle Scholar
  39. 39.
    Coyne TJ, Atkinson RI, Prins JB, 1992 Adrenocorticotropic hormone-secreting pituitary tumor associated with pregnancy: case report. Neurosurgery 31: 953–955.PubMedGoogle Scholar
  40. 40.
    Pinette MG, Pan YQ, Oppenheim D, Pinette SG, Blackstone J, 1994 Bilateral inferior petrosal sinus sampling with corticotrophin releasing hormone stimulation in a pregnant patient with Cushing’s syndrome. Am J Obstet Gynecol 171: 563–564.PubMedGoogle Scholar
  41. 41.
    Guilhame B, Sanson ML, Billaud L, Beragna X, Laudat MH, Luton JP, 1992 Cushing’s syndrome and pregnancy: aetiologies and prognosis in twenty-two patients. Eur J Med 1: 83–89.Google Scholar
  42. 42.
    Villar L, da Coneicao Freitas M, Lima LHC, Lyra R, Kater CE, 2007 Cushing’s syndrome in pregnancy: an overview. Arq Bras Endocrinol Metabol 51: 1293–1302.Google Scholar
  43. 43.
    Murakami S, Saitoh M, Kubo T, Kawakami Y, Yamashita K, 1998 A case of mid-trimester intrauterine fetal death with Cushing’s syndrome. J Obstet Gynaecol Res 24: 153–156.PubMedGoogle Scholar
  44. 44.
    Lindsay JR, Nieman LN, 2005 The hypothalamic-pituitary-adrenal axis in pregnancy: challenges in disease detection and treatment. J Clin Endocrinol Metab 26: 775–779.Google Scholar
  45. 45.
    Lindsay JR, Jonklaas J, Oldfield EH, Nieman LK, 2005 Cushing’s syndrome during pregnancy: personal experience and review of the literature. J Endocrinol Metab 90: 3077–3083.Google Scholar
  46. 46.
    Ross RJ, Chew SL, Perry L, Erskine K, Medbak S, Afshar F, 1995 Diagnosis and selective cure of Cushing’s disease during pregnancy by transphenoidal surgery. Eur J Endocrinol 132: 722–726.PubMedGoogle Scholar
  47. 47.
    Iwase TI, Ohyama N, Umeshita C, Inazaka K, Namiki M, Ikeda Y, 1992 Reproductive and developmental toxicity studies of hCRH (corticotroph releasing hormone [human])(II): Study on intravenous administration of hCRH during the period of organogenesis in rats. Yakuri To Chiryo 20: Suppl 5: 89–102.Google Scholar
  48. 48.
    Ragonese M, Cotta OR, Ferraù F, Trimarchi F, Cannavò S, 2012 How to diagnose and manage Cushing’s disease during pregnancy, when hypercortisolism is mild? Gynecol Endocrinol 28: 637–639.PubMedGoogle Scholar
  49. 49.
    Arnaldi G, Angeli A, Atkinson AB, et al, 2003 Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 88: 5593–5602.Google Scholar
  50. 50.
    Nieman LK, Biller BMK, Findling JW, et al, 2008 The diagnosis of Cushing’s syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 93: 1526–1540.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Lindsay JR, Nieman LK, 2005 The hypothalamic-pituitary-adrenal axis in pregnancy: Challenges in disease detection and treatment. Endocr Rev 26: 775–799.PubMedGoogle Scholar
  52. 52.
    Wang PI, Chong ST, Kielar AZ, et al, 2012 Imaging of pregnant and lactating patients: part 1, evidence-based review and recommendations. AJR Am J Roentgenol 198: 778–784.PubMedGoogle Scholar
  53. 53.
    Casson IF, Davis JS, Jeffreys RV, Silas JH, Williams J, Belchetz PE, 1987 Successful management of Cushing’s disease during pregnancy by transphenoidal adenectomy. Clin Endocrinol (Oxf) 27: 423–428.Google Scholar
  54. 54.
    Ferraù F, Losa M, Cotta OR, et al, 2012 Course of pregnancies in women with Cushing’s disease treated by gamma-knife. Gynecol Endocrinol 28: 827–829.PubMedGoogle Scholar
  55. 55.
    Lekarev O, New MI, 2011 Adrenal disease in pregnancy. Best Pract Res Clin Endocrinol Metab 25: 959–973.PubMedGoogle Scholar
  56. 56.
    Connell JM, Cordiner J, Davies DL, Fraser R, Frier BM, McPherson SG, 1985 Pregnancy complicated by Cushing’s syndrome: potential hazard of metyrapone therapy. Case report. Br J Obst Gynaecol 92: 1192–1195.Google Scholar
  57. 57.
    Leiba S, Weinstein R, Shindel B, et al, 1989 The protracted effect of o,p′-DDD in Cushing’s disease and its impact on adrenal morphogenesis of young human embryo. Ann Endocrinol 50: 49–53.Google Scholar
  58. 58.
    Boronat M, Marrero D, Lopez-Plasencia Y, Barber M, Schamann Y, Nóvoa F J, 2011 Successful outcome of pregnancy in a patient with Cushing’s disease under treatment with ketokonazole during the first trimester of gestation. Gynecol Endocrinol 27: 675–677.PubMedGoogle Scholar
  59. 59.
    Chayuri M, Liu JH, 2007 Ovarian hyperstimulation syndromecaused by pituitary gonadotroph adenoma secreting follicle-stimulating hormone. Obstet Gynecol 109: 547–549.Google Scholar
  60. 60.
    Murata Y, Ando H, Nagasama T, et al, 2003 Successful pregnancy after bromocryptine therapy in a anovulatory woman complicated with ovarian hyperstimulation caused by follicle stimulated hormone-producing plurihormonal pituitary microadenoma. J Endocrinol Metab 88: 1988–1993.Google Scholar
  61. 61.
    Siristatidis C, Mastorakos G, Vitoratos N, et al, 2004 Thyroid hormone resistance and enlargement of the sella turcica during pregnancy. Arch Gynecol Obstet 269: 152–155.PubMedGoogle Scholar
  62. 62.
    Bolz M, Körber S, Schober HC, 2013 TSH secreting adenoma of pituitary gland-rare cause of hyperthyroidism in pregnancy. Dtsch Med Wochenschr 138: 362–366.PubMedGoogle Scholar
  63. 63.
    Chaiamnuay S, Moster M, Katz MR, Kim YN, 2003 Successful management of a pregnant woman with a TSH secreting pituitary adenoma with surgical and medical therapy. Pituitary 6: 109–113.PubMedGoogle Scholar
  64. 64.
    Caron P, Gerbeau C, Pradayrol L, Simonetta C, Bayard F, 1996 Successful pregnancy in a infertile woman with a thyrotropin-secreting macroadenoma treated with somatostatin analog (octreotide). J Clin Endocrinol Metab 81: 1164–1168.PubMedGoogle Scholar
  65. 65.
    Blackhurst G, Strachan MW, Collie D, Gregor A, Statham PF, Seckl JE, 2002 The treatment of a thyrotropin-secreitng macroadenoma with octreotide in a twin pregnancy. Clin Endocrinol (Oxf) 57: 401–404.Google Scholar
  66. 66.
    Bronstein MD, Saigado LR, de Castro Musolino NR, 2002 Medical management of pituitary adenomas:the special case of management of the pregnant woman. Pituitary 5: 99–107.PubMedGoogle Scholar
  67. 67.
    Masding MG, Lees PD, Gawne-Caain ML, Sandeman DD, 2003 Visual field compression by anon-secreting pituitary tumour during pregnancy. J R Soc Med 96: 27–28.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Johnson RJ Jr, Voorhies RM, Witkin M, Robichaux AG III, Broussard WA Jr, 1993 Fertility following excision of a symptomatic craniopharyngioma during pregnancy: case report. Surg Neurol 39: 975–979.Google Scholar
  69. 69.
    Kodama T, Matsukado Y, Miura M, Takada A, 1986 Natural pregnancy and normal delivery after intracapsular irradiation for symptomatic craniopharyngioma-case report. Neurol Med Chir (Tokyo) 26: 40–43.Google Scholar
  70. 70.
    Maniker AH, Krieger AJ, 1996 Rapid reccurence of craniopharyngioma during pregnancy with recovey of visioma case report. Surg Oncol 45: 324–327.Google Scholar
  71. 71.
    Caturegli P, Lupi I, Landek-Salgado M, Kimura H, Rose NR, 2008 Pituitary autoimmunuty: 30 years later. Autoimmun Rev 7: 631–637.PubMedPubMedCentralGoogle Scholar
  72. 72.
    Nishiki M, Muarakami Y, Ozawa Y, et al, 2001 Serum antibodies to human pituitary membrane antigens in patients with autoimmune lymphocytic hypophysitis and infudibuloneurohypophysitis. Clin Endocrinol (Oxf) 54: 327–333.Google Scholar
  73. 73.
    Gutenberg A, Buslei R, Fahlbusch R, Buchfelder M, Bruck W, 2005 Immunopathology of primary hypophysitis. Implications for pathogenesis. Am J Surg Pathol 29: 329–338.PubMedGoogle Scholar
  74. 74.
    Noto H, Tsukamoto K, Hoyashi S, Takano K, Fujita T, Kimura S, 2001 Spontaneous recovery from hypopituitarism in a man with lymphocytic hypophysitis: a case report. Endocr J 48: 483–486.PubMedGoogle Scholar
  75. 75.
    Kalra AA, Riel-Romero RM, Gonzalez-Toledo E, 2011 Lymphocytic hypophysitis in children: a novel presentation and literature review. J Child Neurol 26: 87–94.PubMedGoogle Scholar
  76. 76.
    Bellastella A, Bizzarro A, Coronella C, Bellastella G, Sinisi AA, De Bellis A, 2003 Lymphocytic hypophysitis: a rare or underestimated disease? Eur J Endocrinol 149: 363–376.PubMedGoogle Scholar
  77. 77.
    Caturegli P, Newschaffer C, Olivi A, Pomper MG, Burger PC, Rose NR, 2005 Autoimmune hypophysitis. Endocr Rev 26: 599–614.PubMedGoogle Scholar
  78. 78.
    Rivera J-A, 2006 Lymphocytic hypophysitis: disease spectrum and approach to diagnosis and therapy. Pituitary 9: 35–45.PubMedGoogle Scholar
  79. 79.
    Thodou H, Asa SL, Kontogeorgos G, Kovaks K, Horvath E, Ezzat S, 1995 Clinical case seminar: lymphocytic hypophysitis: clinicopathological findings. J Clin Endocrinol Metab 80: 2302–23011.Google Scholar
  80. 80.
    Gutenberg A, Hans V, Puchner MJ, et al, 2006 Primary hypophysitis:clinical-pathological correlations. Eur J Endocrinol 155: 101–107.PubMedGoogle Scholar
  81. 81.
    Lury KM, 2005 Inflammatory and infectious processes involving the pituitary gland. Top Magn Reson Imaging 16: 301–306.PubMedGoogle Scholar
  82. 82.
    Peruzzotti-Jametti L, Strambo D, Sangalli F, De Bellis A, Comi G, Sessa M, 2012 Bilateral intracavernous carotid artery occlusion caused by invasive lymphocytic hypophysitis. J Stroke Cerebrovasc Dis: 21: 918.PubMedGoogle Scholar
  83. 83.
    Crock PA, 1998 Cytosolic autoantigens in lymphocytic hypophysitis. J Clin Endocrinol Metab 83: 609–618.PubMedGoogle Scholar
  84. 84.
    Castle D, de Villiers JC, Melvill R, 1988 Lymphocytic adenohypophysitis. Report of a case with demonstration of spontaneous tumour regression and a review of the literature. Br J Neurosurg 2: 401–405.PubMedGoogle Scholar
  85. 85.
    Feigenbaum SL, Martin MC, Wilson CB, Jaffe RB, 1991 Lymphocytic adenohypophysitis: a pituitary mass lesion occurring in pregnancy. Proposal for medical treatment. Am J Obstet Gynecol 164: 1549–1555.PubMedGoogle Scholar
  86. 86.
    Kristof RA, Van Roost D, Klingmuller D, Springer W, Schramm J, 1999 Lymphocytic hypophysitis: non-invasive diagnosis and treatment by high dose methylprednisolone pulse therapy? J Neurol Neurosurg Psychiatry 67: 398–402.PubMedPubMedCentralGoogle Scholar
  87. 87.
    Reusch JE, Kleinschmidt-DeMasters BK, Lillehei KO, Rappe D, Gutierrez-Hartmann A, 1992 Preoperative diagnosis of lymphocytichypophysitis (adenohypophysitis) unresponsive to short course dexamethasone case report. Neurosurgery 30: 268–272.PubMedGoogle Scholar
  88. 88.
    Beressi N, Beressi JP, Cohen R, Modigliani E, 1999 Lymphocytic Hypophysitis. A review of 145 cases. Ann Med Interne (Paris) 150: 327–341.Google Scholar
  89. 89.
    Sheehan HL, 1965 The frequency of post-partum hypopituitarism. J Obstet Gynaecol Br Commonw 72: 103–111.PubMedGoogle Scholar
  90. 90.
    Feinberg EC, Molitch ME, Endres LK, Peaceman AM, 2005 The incidence of Sheehan’s syndrome after obstetrics hemorrhage. Fertil Steril 84: 975–979.PubMedGoogle Scholar
  91. 91.
    Kelestimur F, 2003 Sheehan’s Syndrome. Pituitary 6: 181–188.PubMedGoogle Scholar
  92. 92.
    Dejager S, Gerber S, Foubert L, Turpin G, 1998 Sheehan’s Syndrome: differential diagnosis in the acute phase. J Intern Med 244: 261–266.PubMedGoogle Scholar
  93. 93.
    Lavalee G, Morcos R, Palardy J, Aube M, Gilbert D, 1995 MR of nonhemorrhagic postpartum pituitary apoplexy. Am J Neuroradiol 16: 1939–1941.Google Scholar
  94. 94.
    Dash RJ, Gupta V, Suri S, 1993 Sheehan’s Syndrome: clinical profile, pituitary hormone responses and computed sellar tomography. Aust N Z J Med 23: 26–31.PubMedGoogle Scholar
  95. 95.
    De Bellis A, Kelestimur F, Sinisi AA, et al, 2008 Anti-hypothalamus and anti-pituitary antibodies may contribute to perpetuate the hypopituitarism in patients with Sheehan’s syndrome. Eur J Endocrinol 158: 147–152.PubMedGoogle Scholar
  96. 96.
    Kelestimur F, Jonsson P, Molvalilar S, et al, 2005 Sheehan’s Syndrome: baseline characteristics and effect of 2 years of growth hormone replacement therapy in 91 patients in KIMS. Eur J Endocrinol 152: 581–587.PubMedGoogle Scholar
  97. 97.
    Soares DV, Spina LD, De Lima Oliveira Brasil RR, et al, 2006 Two years of growth hormone replacement therapy in a group of patients with Sheehan’s syndrome. Pituitary 62: 127–135.Google Scholar
  98. 98.
    See TT, Lee SP, Chen HF, 2005 Spontaneous pregnancy and partial recovery of pituitary function in a patient with Sheehan’s syndrome. J Chin Med Assoc 68: 187–190.PubMedGoogle Scholar
  99. 99.
    Regal M, Páramo C, Sierra SM, Garcia-Mayor RV, 2001 Prevalence and incidence of hypopituitarism in an adult Caucasian population in northwestern Spain. Clin Endocrinol (Oxf) 55: 735–740.Google Scholar
  100. 100.
    Bülow B, Hagmar L, Mikoczy Z, Nordström CH, Erfurth EM, 1997 Increased cerebrovascular mortality in patients with hypopituitarism. Clin Endocrinol (Oxf) 46: 75–81.Google Scholar
  101. 101.
    Trainer PI, 2002 Corticosteroids and pregnancy. Semin Reprod Med 20: 375–380.PubMedGoogle Scholar
  102. 102.
    Abalovich M, Amino N, Barbour LA, et al, 2007 Management of thyroid dysfunction during pregnancy and postpartum: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 92: Suppl: 1–47.Google Scholar
  103. 103.
    Pop VJ, Brouwers EP, Vader HL, Vulsma T, van Baar AL, de Vijlder JJ, 2003 Maternal hypothyroxinemia during early pregnancy and subsequent child development: a 3-year follow up study. Clin Endocrinol (Oxf) 59: 282–288.Google Scholar
  104. 104.
    Sakai S, Wakasugi T, Yagi K, et al, 2011 Successful pregnancy and delivery in a patient with adult growth hormone deficiency: role of GH replacement therapy. Endocr J 58: 65–68.PubMedGoogle Scholar
  105. 105.
    Salle A, Klein M, Pascal-Vigneron V, Dousset B, Leclere J, Weryha G, 2000 Successful pregnancy and birth after sequential cotreatment with growth hormone and gonadotropins in a woman with panhypopituitarism: a new treatment protocol. Fertil Steril 74: 1248–1250.PubMedGoogle Scholar
  106. 106.
    Kallen BA, Carlsson SS, Bengtsson BK, 1995 Diabetes insipidus and use of desmopressin (Minirin) during pregnancy. Eur J Endocrinol 132: 144–146.PubMedGoogle Scholar
  107. 107.
    Ray JG, 1998 DDAVP use during pregnancy: an analysis of its safety for mother and child. Obstetr Gynecol Sur 53: 450–455.Google Scholar

Copyright information

© Hellenic Endocrine Society 2015

Authors and Affiliations

  • Alexandra Chrisoulidou
    • 1
  • Maria Boudina
    • 1
  • Niki Karavitaki
    • 3
  • Eleni Bill
    • 2
  • John Wass
    • 3
  1. 1.Unit of Endocrinology, Theagenio HospitalAristotle University of ThessalonikiThessalonikiGreece
  2. 2.1st Department of Obstetrics & GynaecologyAristotle University of ThessalonikiThessalonikiGreece
  3. 3.Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and MetabolismChurchill HospitalOxfordUK

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