POSTPARTUM HYPOPITUITARISM IN PATIENTS WITH TYPE 1 DIABETES MELLITUS

Abstract

Formulation of the problem. Panhypopituitarism is a rare endocrine disease with variable clinical presentations, ranging from asymptomatic to life threatening condition. Postpartum Panhypopituitarism (Sheehan's syndrome) is a well-known clinical condition that has been attributed to massive ante or postpartum hemorrhage. Postpartum hypopituitarism on the other hand, which develops after normal delivery, is a rare condition. It is mostly attributed to lymphocytic hypophysitis. In Type 1 DM patients that has been attributed to antepartum pituitary necrosis, which is a very rare condition. Analysis of recent research and publications. Lymphocytic hypophysitis or autoimmune hypophysitis is a disease characterized by lymphocytic infiltration of the pituitary gland, which eventually leads to destruction of pituitary tissue accompanied by various clinical presentations of pituitary dysfunction. Formulating the purpose of the article. The purpose is to present a case of hypopituitarism and empty Sella in a Type1 diabetic patient, diagnosed postpartum after long-suffering, who has achieved full term pregnancy andnormal deliveryis reported. Diagnosis of lymphocytic hypophysitisor antepartum pituitary necrosis was raised as the cause of the hypopituitarism. Presenting main material. Here we describe a case of Type 1 diabetic patient with postpartum panhypopituitarism and empty Sella. The condition may be related to either autoimmune hypophysitis or anterior pituitary necrosis during pregnancy. Discussion: Is this a case of Lymphocytic Hypophysitis during pregnancy? – because she was on her second trimester of pregnancy! She developed severe headache, nausea, vomiting, general weakness with hypoglycemic attacks, and sensitive hyperglycemia (where only small doses of insulin are needed to control that) with symmetrical pituitary enlargement which was seen in Brain MRI even contrast was not given. The patient’s condition was explained as non-specific aseptic meningitis. The endocrine deficiency in our patient was due to anterior pituitary hypopituitarism, initially manifested by amenorrhea, failure of lactation and later diagnosed as ACTH and TSH deficiency. Growth hormone and IGF1 were not evaluated at that time. This case is a diagnostic feature of autoimmune hypophysitis panhypopituitarism. Conclusions and perspectives of further research. We conclude that any headache of sudden onset associated with nausea and vomiting during pregnancy and a suggested picture of pituitary insufficiency should be considered an alert of pituitary disorder that cannot be explained as pregnancy related symptoms, or non- specified meningitis. Furthermore, to be careful in interpreting images not specific to pituitary gland. This conclusion was established based on the early steroids treatment that could prevent the progression of the pituitary destruction and/or early identification of the condition with early replacement therapy. This should prevent long-suffering of such patients.