Case presentation of a young woman with pituitary macroadenoma and implications of fertility

Endocrine Nurses Training Course 2005, John MacIntyre Centre, The University of Edinburgh, 18 Holyrood Park Road, Edinburgh EH16 5AY, UK
30 August - 1 September 2005

A 36-year-old female presented to the endocrine clinic with a one year history of amenorrhoea following discontinuation of the oral contraceptive pill. Her associated symptoms were night sweats, tiredness and frequent headaches. On examination she had, ‘oily skin’ enlarged hands and a visual field defect.

Pituitary function showed Prolactin elevated at 816 mU/L with suppression of other pituitary hormones. LH < 0.5 IU/L, FSH 0.7 IU/L, TSH 0.80 mU/L. Short Synacthen test -0 minutes cortisol = 462 nmol/L with 30 minutes=945 nmol/L. IgF-1 elevated at 143.3 nmol/L, with non-suppression of growth hormone on oral glucose tolerance test (growth hormone values ranging from 94-157.5mIU/L).

MRI revealed a large pituitary lesion extending superiorly as well as well as laterally.

Transphenoidal surgery was performed in November 2003 followed by radiotherapy. She is presently maintained on Somatuline Autogel 120mg monthly and Cabergoline 0.5mg twice weekly. Other replacement therapy includes Hydrocortisone 20mg, Thyroxine 50 mcg and the oral contraceptive pill.

She now wishes to get pregnant and discussed fertility issues.

Points for discussion

1. Safety issues during pregnancy
   a) enlargement of pituitary lesion
   b) use of medications in pregnancy
2. Follow up investigations during pregnancy
3. Brief outline of fertility treatment in patients with hypopituitarism
   

Revised: 19-Sep-2005